The issue of balance billing is getting fresh attention on Capitol Hill and with good reason: Patients should never receive a bill they didn’t expect or cannot afford. Nor should they be put in the middle during a health care crisis, especially for life-saving services like emergency air medical transport. But proposed legislation in the House would empower insurers to reduce patient access to this vital emergency care.
Addressing balance billing is complicated. There are currently three different proposals in Congress that approach the issue in varying ways. While the House Ways & Means Committee has advanced a proposal that attempts to address the root cause of balance billing, the House Education and Labor panel has introduced legislation that could severely limit access to air medical services for patients across the country.
That legislation, the Ban Surprise Billing Act of 2020, would allow insurers to pay the “median in-network rate” for air medical services. However, many insurers refuse to bring providers in-network in the first place, or in some cases, they only bring in one emergency air medical provider. Because a median in-network rate cannot be set if there are no providers in-network, insurers will be able to essentially set their own rates. This would further jeopardize the ability of emergency health care providers to continue operating, and what’s worse, it would hinder patient access to emergency, life-saving care — particularly for those living in rural communities.
What’s more, this approach does nothing to address the bad practices of some private insurers, such as pursuing narrow networks or denying coverage based on “medical necessity” after the fact. All the while, these insurers enjoy — and boast about — billions of dollars in handsome tax breaks and record profits.
Emergency air medical services and other providers like doctors and hospitals have been scrutinized because of anecdotal stories about large balance bills some patients receive. Unfortunately, most of these stories fail to point out the root cause of the problem: denials by private insurers and chronic under-reimbursement by government payers for life-saving medical care. Despite this, the Education and Labor proposal would reward insurers for bad behavior.
Take for instance, UnitedHealth, one of the largest insurers in the country. It has no network agreements with emergency air medical outside the hospital setting. Its customers are on the hook for air medical transport, despite paying premiums to cover them in an emergency. In the meantime, UnitedHealth reported fourth-quarter earnings for 2019 of $3.54 billion, an increase from $3.04 billion during the same time the previous year.
Adding insult to injury, insurers have taken advantage of business- and tax-friendly policies — such as the 2017 tax reform — to propel profits to head-spinning levels. In the first half of 2019, Health Care Service Corporation (the parent company of five Blue Cross Blue Shield plans and the fourth largest health insurer in the U.S.) reported a net profit totaling $2.3 billion. More than $450 million of that was “earned” from a tax refund. Over the same time period, the company paid zero dollars in federal income tax. The year before, HCSC received a staggering $1.7 billion tax refund. So just as insurers are benefiting from record profits and tax breaks, they continue to go to great lengths to harm their customers.
Fortunately, the Ways and Means proposal —the Consumer Protections Against Surprise Medical Bills Act of 2020 — shows there is a better solution. It advocates the collection of cost data from both providers and insurers to evaluate the underlying causes of balance bills. This tracks with the work of the Transportation Department’s Air Ambulance and Patient Billing Advisory Committee that was commissioned with bipartisan support in 2018. That panel has been charged with developing data-driven recommendations for protecting patients from balance billing; providing transparency from providers and insurers alike; and preserving access to emergency care.
Congress has an important decision to make when it comes to balance billing: preserve emergency medical services or reward the insurance industry for bad practices. For patients, the choice is clear.
Carter Johnson is the spokeswoman for the Save Our Air Medical Resources, or SOAR, campaign, which advocates preserving access to emergency air medical services across the country.