As a citizen of the great state of Texas, I am curious about the introduction of several bills designed to “ensure health plans are discouraged from underpaying providers.” – Jeff Evans
To Jeff’s point, David Silverstien addresses a basic problem with government interference in our health care system:
“We recommend extensive legislative education. We genuinely believe that legislators do not understand the true nature of healthcare pricing and that, as the paramount issue of our time, they must. Our form of government is grounded in the expectation that the citizenry elect wise and noble people who then study the issues before them to an extent not possible by the general public. The nature of healthcare pricing is such that the limited knowledge of legislators is approaching the danger level.” – David Silverstien
As a citizen of the great state of Texas, I am curious about the introduction of several bills designed to “ensure health plans are discouraged from underpaying providers.” I noticed that there is no mention of providers overcharging providers. I completely agree that consumers should have protections from balance bill charges. However, my concern is that these bills seem to take a one-sided approach in regulating what health plans can or cannot do. Why are we not trying to address both sides of the issue?
Having been in the insurance business for over 20 years, I have reviewed numerous claims. I have noticed in the last 10 years or so that most ER service providers have moved away from contracting with provider networks for a set rate, thereby allowing them to bill whatever they want. This problem is exacerbated when the consumer goes to a “network” facility to try to maximize the benefits under their health plan, only to receive a bill from “non-network” providers at a higher amount than expected.
If we are truly going to address transparency, shouldn’t we address this issue also? Shouldn’t we address transparency for all sides of the situation? Why do these providers need to charge rates many time higher than the equivalent services can be provided in a different setting? If the goal is transparency, then why not publish the rates being charged upfront, before services are rendered? Healthcare is the only service in our economy that a consumer never really knows the cost until after it is performed. If the cost are published and Transparent then the consumer can make a more informed design about where they want to receive services. Instead of receiving an inflated charge the health plan and provider then have to argue about what is “usual and customary.”
The best part of making healthcare costs more transparent is that ultimately it would help make insurance more affordable, and allow consumers to make informed decision. Or, allow charges to be benchmarked against the only common healthcare benchmark, Medicare. Then, if one provider wants to charge 900% of what Medicare pays they can simply explain to the consumer why they are worth it, vs another provider that only charges 250% of Medicare.
I encourage you to address both sides of the issue, only addressing one side will simply cause insurance rates to increase.
Thank you for your time. I hope you will give what I have brought up some consideration.