In recent years, the issue of out-of-network or surprise medical billing has placed a stain on medical practice, making patients experiencing medical emergencies fearful of obtaining care because of concerns over cost. Insurers often claim that physicians try to be out of network because of greed and a desire to bill unfair rates. This narrative of the greed-driven physician has come to dominate the conversation and the imagination of the public, but it is not the truth.
The truth is that Colorado physicians have among the lowest rates of out-of-network care in the country. We rank 42nd out of 50 states in out-of-network billing, with only 6 percent of physicians billing out of network.
Exorbitant fees are far more rare. Physicians across Colorado overwhelmingly contract with insurers and do so in good faith. Physicians in Colorado are not driven by greed, but by our dedication to serving patients and our communities. In the emergency room, we care for all patients who present to our doors, regardless of ability to pay, and provide more charity care than any other medical specialty.
Colorado emergency physicians are not driven by profits and the proof comes in the numbers regarding physician compensation. Colorado ER doctors are the lowest compensated ER doctors in the nation, ranking 50th out of 50 states.
Juxtapose that against insurance companies that are driven by little more than maximizing profits. United Healthcare, one of Colorado’s largest insurers, announced that its first quarter profits for 2019 were $3.47 billion. Anthem just announced a $1.6 billion first quarter profit. In 2018, United compensated its chief executive officer $21.5 million.
What has happened to health insurance premiums and patient out-of-pocket costs in the midst of this health insurer windfall? They’ve universally increased.
Insurers have been experiencing record profits by shifting costs onto patients via high deductible plans, narrow networks and neglecting to pay bills they owe. Insurers in our state purposefully neglect to inform many patients of current state law that requires insurers to pay the balance of the bills, often hoping that patients will pay what is by law the insurers’ responsibility. At a recent state Senate hearing, the insurance commissioner expressed horror at the cost-shifting games insurers play, while generally ignoring the insurers that abuse the system until an informed patient makes a direct complaint.
In the state House of Representatives, insurance agencies and advocates have successfully lobbied and created a bill which now promises to punish Colorado physicians, who have overwhelmingly played by the rules. In essence, the bill would set maximum rates for physician billing and payment that are favorable for insurers and below many currently existing contracts.
Insurers will be incentivized to cancel contracts that are above set rates and there is nothing in the bill that would require savings to be passed on to patients. Even the senators who sponsor the bill admit that most physicians don’t abuse out-of-network billing. However, they have created a bill that punishes all physicians, not just the abusers of out-of-network billing.
The result for emergency medicine will be catastrophic. As physician compensation continues to decline, emergency physicians and the specialists who care for Coloradans in their greatest times of need will leave the state. We will be unable to recruit the best and brightest emergency physicians to Colorado and the safety net our citizens depend on will be harmed.
Wait times will increase, transfers to hospitals far from where patients live will increase and potentially closures of local emergency rooms may occur. In short-staffed emergency departments and hospitals, such as Pueblo and other rural communities, the effects will likely be the greatest.
Emergency physicians and the majority of physicians in the state support legislation that would end egregious out-of-network billing practices by a few bad actors, but this bill goes overboard. We can reign in out-of-network billing without punishing physicians and enriching already highly profitable insurance companies.
We beseech our lawmakers to take our citizens access to emergency care into account and to vote against House Bill 1174. We can solve the problem of out-of-network billing in a thoughtful way which does not harm to Colorado’s emergency care system.
Don Stader is an emergency physician and the president of the Colorado chapter of the American College of Emergency Physicians. David Friedenson is an emergency physician and the chief medical officer for Reventics.