The Potential Pitfalls from Methods to End Surprise Billing in Healthcare

In an era of almost unprecedented partisan enmity there are few issues that have the ability to unite both political parties in a common desire to effect change. The problem of surprise billing has proven to be precisely one such issue, and Congress appears intent on passing legislation to address the problem by year end. Surprise billing occurs when a patient unknowingly gets treated by a provider not in her network, and afterward receives a bill well above the customary co-pays, co-insurance, and deductibles for which patients are typically responsible. These bills can be substantial. At the moment there is no clear consensus on precisely how to reduce the incidence of surprise billing. Congress is currently considering three broad solutions: the first is for the government to set the out-of-network price in such situations at some measure of local healthcare prices, with the local, median in-network rate as the leading proposal; another is an in-network guarantee requiring that all providers operating at an in-network healthcare facility join the same networks as the facility or be considered in-network for billing purposes; and the third would direct providers and insurers to settle the charge between the two of them via an independent dispute resolution process. We believe that economic theory – and the available evidence – suggest that creating an independent dispute resolution mechanism to arbitrate the price differences would have the least impact on broader healthcare markets and should be the preferred solution.