St. Louis Post-Dispatch: Protect families from sticker shock on surprise medical bills

“Sticker shock” (March 11) by Samantha Liss exposed the devastating effects of both narrow health insurance provider panels and the practice of unanticipated “balance billing.”

First and foremost, we are sincerely thankful that the young patient survived his accident, received the necessary treatment and has no lasting effects from his injuries. That his family is caught in a financial dispute between insurer and service provider is a deeply unfortunate result.

In a life-threatening emergency, one cannot reasonably expect a distressed parent to take time to confirm that the service provider is part of their network. We urge Anthem and Air Evac Lifeteam to work cooperatively to resolve this dispute quickly and take steps to prevent similar situations in the future.

The physicians of the St. Louis Metropolitan Medical Society advocate for eliminating the practice of this type of balance billing, especially in a situation that limits a patient from knowing the network status of a provider. 

Missouri Senate Bill 1057, recently introduced by state Sen. Jill Schupp, modifies provisions related to surprise billing or unanticipated out-of-network health care services. Under the terms of this bill, out-of-network physicians practicing at in-network facilities will no longer be able to balance-bill patients. In exchange for giving up the ability to do that, insurance carriers will be asked to pay the physicians directly based on certain payment benchmarks. For the health care provider, a process for mediation would be available to challenge the reasonableness of their payments based on enumerated criteria. Most importantly, for the patient, it would mean greater access to care at a more affordable cost.

We believe Sen. Schupp’s bill is a step in the right direction for protecting patients and families from future sticker shock situations like this family experienced.

Dr. Christopher A. Swingle  •  Creve Coeur

President, St. Louis Metropolitan Medical Society

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