HOLDING THE BAG

This is an article I authored in December 2020 for the US Cattlemen’s Association and submitted to the Blue Ridge Independent on surprise medical billing and how this is a predatory practice on many Americans especially in rural America. It was recently placed front and center in my mind when one of my patients was life flighted (quite inappropriately) for a medical emergency that turns out to not have been

a true medical emergency. Yet the hospital and emergency physician that were in charge of his health and wellbeing inappropriately transported him (through pressure and coercion) via LifeFlight to a larger medical center. I’m sure his treating physician felt he was using proper judgement but now the patient is left holding the bag with a huge transportation bill.

Current Surprise Billing Debate Another Loss for Rural Healthcare

By Dr. Brooke Miller, MD

Surprise medical billing is becoming a hot button issue among patients, healthcare providers, hospitals and insurance companies. It is an awful reality that many patients face when they receive out-of-network charges for healthcare services that health insurance providers will not cover. No matter what service you need, whether it is a prescription drug or emergency air transport, there is a strong chance that you will be stuck with a high bill that’s more than you can afford.

Other times, insurers ask hospitals and emergency departments to pass on the cost to patients for out-of-network care. Rural Americans are disproportionately affected by this deeply troubling issue, due to the distances that they often have to travel for emergency and specialty care.

With many rural hospitals closing and consolidating, emergency care for some Americans is getting further and further away. The “golden hour” is a term used in medicine to describe the importance and critical nature of treatment rendered in the first hour following a traumatic injury and is of the utmost importance for patient outcomes and survival. Approximately 85 million Americans have access to a Level 1 or 2 Trauma Care Facility within one hour, but only if flown. Nearly 90% of those patients transported by air medical services are from rural zip codes. With the continuing decline of rural trauma centers, the need for timely and reliable air medical transportation is more important than ever.

According to the Government Accountability Office, in 2017 the median cost for an emergency helicopter flight was $36,400 (up 60% from 2012). Two-thirds of those flights were “out-of-network.”  When an emergency strikes, patients cannot stop and take the time to research what transport team or which hospital is in or out of network.  What’s more troubling is that when insurance companies deny coverage, air ambulance services can bill exorbitant “out-of-network” prices. Thus, there is little incentive for these companies to negotiate contracts with insurers to become “in network.”

The current “solution” brought forth by the United States House of Representatives to tackle the surprise billing issue is troubling. These bills absolve insurers of responsibility and, in many cases, even allow them to walk away from covering certain emergency services they deem too expensive. As a result, insurance companies are making record-breaking profits and rationing care, while patients are paying higher and higher premiums as fewer services are covered.

Take patients out of the disputes between emergency services, doctors, hospitals and insurance companies. Doctors and hospitals need to receive fair reimbursements to sustain their medical practices and to ensure quality of care. Adequate networks should be expanded, especially in rural communities, which would go a long way in solving the problem of surprise medical billing. Increased transparency from insurance companies on coverage should be demanded.

It has always been my feeling that we should increase competition in the marketplace by expanding insurance networks. Health insurance should be used for catastrophic medical coverage, as no person should have to worry if emergency services or any other expensive care will be covered.

Rural Americans have been consistently left behind when it comes to medical services. We cannot allow this latest example of consumer price gouging to win over the health and well-being of our patients. A majority of voters favor a fix by reimbursing providers fair market rates while not allowing insurance companies to walk away from unreimbursed services. Senator Tim Kaine, please do not give insurance companies a pass on surprise medical billing.

Dr. Brooke Miller is generational cattle rancher and board certified in Family Medicine. He has 34 years’ experience in family and emergency medicine serving rural communities in Montana and Virginia. He currently serves as president of the United States Cattlemen’s Association.