By Philip A. Verhoef, M.D.
USA Today, March 9, 2020
Congress is grappling with the problem of surprise medical bills, but will its Band-Aid approaches make a difference? As a physician, Iâm trained to look beyond superficial symptoms to diagnose the underlying ailment. When patients pay thousands of dollars each year for âgoodâ private insurance, how does a health care system allow them to walk away from a single hospital visit with debilitating medical debt? These concerns have become even more pressing with the spread of the new coronavirus and the costs associated with prevention, testing and treatment.
Most Americans assume that a commercial insurance card in their wallet protects them from unexpected medical bills. They pay their premiums and deductibles, scour the pages of insurance fine print and keep up with the revolving door of âin-networkâ doctors and hospitals.
However, going to the âin-networkâ hospital is no guarantee that the emergency room doctor, radiologist or anesthesiologist will be âin-network.â Today, many hospitals no longer directly employ physicians but instead contract with physician staffing firms such as TeamHealth, which employs more than 16,000 clinicians at 3,300 medical facilities.
Caught unaware in a medical crisis
These agencies are extremely profitable, which is why private equity firms are so hungry to buy them. Contract physicians operate outside of insurance coverage agreements â theyâre not part of any ânetworkâ â and can act like free agents, billing patients directly for services not covered by insurance, called âbalance billing.â
What does this mean for patients? Imagine youâre having a heart attack and call 911. Paramedics transport you to the nearest emergency room, which may or may not be in your insurerâs network. And because that hospital â or the ER doctor on duty â Â does not have a contractual relationship with your insurer, they can essentially name their price and âbalance billâ you for the amount the insurance company wonât cover.
Here in Hawaii, many critically ill patients must use air ambulances for transportation from their home island to one that can provide emergency specialty services. For one of my patients, an air ambulance was a life-or-death necessity but deemed âout of networkâ by their insurance. Weeks later, the family received a balance bill for more than $25,000. They were forced to file bankruptcy and then enroll in Medicaid to cover subsequent health care costs â all with an insurance card in their wallet.
If this hasnât happened to you, itâs just a matter of time. Over 40% of privately insured patients face surprise medical bills after visiting emergency rooms or getting admitted to hospitals. These bills punch a major hole in most family budgets: The average surprise hospital bill is $628 for emergency care and $2,040 for inpatient admission. Thatâs on top of the more than $20,000families pay in premiums and deductibles each year just for the insurance policy.
If faced with a surprise $500 medical bill, half of Americans would either have to borrow money, go into debt or wouldnât be able to pay it at all. Medical bills are a key contributor in two-thirds of personal bankruptcies, and yet the vast majority of households filing for medical bankruptcy have insurance.
Medicare for All is the only solution
What is the value of commercial insurance if it canât protect us from financial ruin?
Lawmakers are considering a number of policies that would prohibit balance billing, cap the amount patients pay at out-of-network facilities and implement baseball-style arbitration when providers and insurance companies canât agree on a payment. But surprise bills are not the real problem â they are merely one symptom of a dysfunctional system based on private insurance. And insurance companies only turn a profit by restricting patient choice, denying claims and passing costs onto enrollees.
The only policy that can end this scourge for good is single-payer Medicare for All, which would cover everyone in the nation for all medically necessary care. Medicare for All would eliminate out-of-network bills, because every doctor and hospital would be covered. Patients would never see a medical bill again, because Medicare for All would pay doctors and hospitals directly, with no deductibles, co-pays or insurance paperwork to get in the way.
Right now the current Medicare system is covering the costs of coronavirus testing, protecting patients just as it was designed to do. This health emergency is another argument for expanding such protections to all Americans.
Working in various hospitals across the country, I have met so many patients who delay or avoid needed care for fear of surprise bills and financial catastrophe. That’s risky for them and, in the face of a threat like coronavirus, for all of us. It doesnât have to be this way. As a doctor, I prescribe Medicare for All.
Dr. Philip A. Verhoef is an intensive care unit physician in Honolulu, Hawaii. Follow him on Twitter: @DrPhilipVerhoef.
