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How to crack down on surprise medical bills

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).
Data: Brookings; Chart: Harry Stevens/Axios

Details: The paper recommends 2 fixes:

  1. 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.
  2. 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.

Go deeper: Why ending surprise medical bills is harder than it looks