A new Brookings Institution paper outlines ways to prevent patients from receiving surprise medical bills — particularly the patients who are unlikely to know their doctor is out-of-network.
The big picture: The paper argues that any solution must take into account that health care settings often are not normal markets.
- Patients either aren't in a position to make choices (like in an emergency room), or don't have a choice of doctor (like anesthesiologists or radiologists in a hospital).
Details: The paper recommends 2 fixes:
- States could cap out-of-network provider rates in these situations, limiting patients' cost-sharing to what they'd normally pay for in-network services.
- Separate billing would be banned for out-of-network doctors at in-network facilities. Insurers would instead pay the hospital a certain amount and then that facility would pay providers for their services.