I am writing to express my deep concern over proposals in Congress to address surprise medical billing by allowing private health insurers to set artificially low reimbursement rates to providers, a process called “rate setting.” If such a policy were adopted into law, it would result in reduced access and care for those patients most in need.

Surprise medical billing affects millions of Americans each year who need urgent, often life-saving care, but come to discover weeks or month later that their insurance company is denying coverage and leaving them with a hefty bill for their treatment. Unfortunately, many of the plans being discussed in Congress are hand-outs to insurance companies who are more concerned with profit seeking than helping patients. If insurance companies were to reimburse at below-market rates for services, they would be increasing costs to health care facilities, doctors and patients. This could seriously jeopardize the number and quality of doctors and health care facilities, especially in rural areas, where residents already have reduced health care options.

But with independent dispute resolution, patients are taken out of the middle in billing disputes between insurers and providers, and an objective, third-party mediator works to determine fair-market value for services provided. We have seen this system work in states such as Texas and New York, where there has been a reduction of thousands of surprise medical bills, saving consumers over $400 million. This should be a model for Congress.

This issue deserves thorough debate and deliberation in Congress, and legislation to address surprise medical billing shouldn’t be bought and paid for by giant health insurance companies. I strongly urge you to embrace the value and opportunity that a fair market-driven solution can provide for patients, providers, and insurers through independent dispute resolution.

Rep. Shelley Rudnicki


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