Let’s suppose that you were out running—sticking to your New Year’s resolution, of course—and suddenly the ground comes up from beneath you. You’ve fallen, and you’ll need minor surgery to repair a moderate injury.
Being the responsible adult that you are, you’ve called your insurance provider to confirm that both your hospital and doctor are in-network, as well as the modest copayment involved—nothing exceptional.
One month later, you’re staring at a bill for 15,000 dollars. It must be a mistake.
A few phone calls later, you realize that it’s not. The bill had come from the out-of-network anesthesiologist who was managing your surgery. Just like that, it’s not a reasonable copay you are dealing with, but tens of thousands of dollars.
Seems preposterous, right? Almost inconceivable?
Unfortunately, such a scenario isn’t by any means an obscure hypothetical, a product of carelessness and negligence on behalf of the patient. This phenomenon of “surprise billing”—when patients receive unexpected and expensive charges after out-of-network care—affects nearly 57 percent of adults in America. Most of these bills are the result of trips to the emergency room: The Kaiser Family Foundation found that 18 percent of all emergency visits end with at least one out-of-network charge, while another study found that 51 percent of ambulance rides were likely to result in a surprise medical bill.
An individual who is transported to an emergency department by an ambulance might wake up to a bombshell: an out-of-network bill that likely tacks on over $14,000 to the cost, according to a study published in the Journal of the American Medical Association.
Say that you are able to sidestep the expensive ambulance service, and your neighbor drives you to an in-network hospital that, by the way, may not necessarily be the nearest emergency room. You are still at risk of being ambushed by bills worth many thousands of dollars: According to a study by the Kaiser Family Foundation, 16 percent of in-network hospital stays end in surprise bills.
This egregious practice of surprise billing is employed by some physicians, often emergency doctors and anesthesiologists, who seek more money than what insurers offer. They look to maximize their profits by staying out of insurance networks and billing patients directly, burdening unsuspecting individuals with brutally large bills.
The practice represents a gaping hole in our healthcare system—it is a part of a horrendous battle for revenue in which vulnerable patients are swept up, forced to bear the weight of tens of thousands of dollars in financial burden.
Outwardly, it seems like politicians recognize, acknowledge, and condemn the practice. In his State of the Union Address last January, and again in May, President Trump called for new legislation to curtail surprise billing. Some states have created laws to reduce surprise billing, though their efforts are limited in scope with most employer-sponsored insurance plans being out of their jurisdiction. In this year’s primaries, presidential candidates have been vocal about efforts to address the issue. The Senate Health, Education, Labor and Pensions Committee alongside the House Energy and Commerce Committee appear to be advancing on bipartisan legislation as well. Yet none of these efforts have paved the way for real and lasting change.
It’s easy to speculate why this might be. We could blame it on the inefficiencies of lawmakers in Congress. We could point to alliances between health providers and Capitol Hill. Whatever the barrier is, it’s hard to believe that it’s preventing legislation that would protect nearly two thirds of Americans from grievous financial strain.
Surprise billing, in every sense, is morally distasteful and irreconcilable with the fiduciary responsibilities of physicians towards their patients. How can doctors swear by the Hippocratic Oath to “do no harm,” only to go on exploiting vulnerable individuals? It is the duty of a physician to put their patient’s best interests before all else, as it is the duty of legislators to hold the public’s interests above their own.
Far-reaching developments are needed to ensure that Americans aren’t grasping for healthcare when they most need it. And these changes are long overdue.