Independent dispute resolution offers best fix for senior citizens, rural communities to address “surprise billing” problem

by | Jan 23, 2020

Florida may be known as the Sunshine State but that it wouldn’t be unfair to call it the Senior State either. Florida has the second-highest senior population in the nation following California and the numbers keep growing.  For seniors and others living on a fixed income, health care expenses can quickly spiral out of control. The Florida Department of Elder Affairs own Profile of Older Floridians paints a bleak picture of the finances and medical coverage of seniors in the state.

Some of the scariest numbers in the Elder Affairs report are that over 923,000 Florida seniors are “medically underserved” and over 586,000 receive food stamps or SNAP. The numbers for seniors with disabilities are staggering. More than 793,000 seniors have one type of disability while an additional 872,568 seniors have two or more disabilities. This means there’s a lot of healthcare needs and a lot of healthcare visits needed in the state.

One of the scariest things for seniors who are often on fixed incomes are surprise bills, and yet those bills have become commonplace in their lives. Seniors go to a physician thinking that their healthcare coverage will cover the costs, only to find out when the bill comes that something wasn’t covered. The problem is that these bills are a direct result of poor communication and poor planning between parties who end up passing along their cost to the patients.

This can’t continue.

Congress needs to immediately rein in these burdensome costs and address the issue of surprise medical billing—an unfair practice that sticks patients with outrageously high bills for treatment or procedures they thought would be covered by insurance.

While it is undoubtedly a sign of progress that many in Congress are finally acknowledging the problem that is vexing their constituents around the nation, and are working to resolve this matter, it is extremely important for legislators to take the correct approach.

Seniors and others living on a fixed income could find themselves protected from high bills but unable to find doctors willing to care for them if current legislation under consideration becomes law. This “solution” would have a decidedly negative impact on health care access, particularly for seniors and patients living in one of Florida’s many rural communities. It is critical for Congress to make sure they don’t create a problem while trying to solve another.

Working on behalf of America’s greatest generation, the American Senior Alliance believes a process known as Independent Dispute Resolution (IDR)—which has been proposed in other legislative measures—offers the best possible solution. Essentially, IDR would ensure patients are only responsible for their standard, in-network cost-sharing amounts by enabling providers and insurers to enter into a simple, transparent negotiation process to settle out-of-network payment disputes as they arise.

Through IDR, each party would be incentivized to submit their most reasonable payment amounts through an online platform. Within 30 days or less, an unbiased, third-party mediator would set a final payment taking these offers—as well as a host of independent data and factors—into consideration. This open process ensures payments not only reflect the true cost of providing care but are sufficient enough to support the ongoing delivery of health care for seniors and rural communities.

The same simply cannot be said about the solution being proposed, which takes a “benchmarking” approach to set out-of-network rates. Under this benchmarking model, rates for physicians’ would be set by out of touch bean counters in the government and tied to the drastically discounted in-network rates insurers secure during contract negotiations with physicians. Slashing physician reimbursements in such a manner would transfer enormous losses onto local hospitals and emergency rooms, many of which are already contending with their own financial woes at it is.

Particularly for rural communities that already lack sufficient access to care and senior populations that often rely more heavily on emergency services, a benchmarking approach to ending surprise medical billing could be disastrous. It could force many facilities on which these patients rely to cut services or staff, or even increase consolidation or closure rates—threatening access while driving up costs for those who can least afford it.

Senator Rick Scott will play a significant role in the outcome of this issue, especially given his background in health care. With so many older Americans choosing Florida as their retirement destination, Senator Scott should help support IDR and protect seniors’ hard-earned money and access to vital health care services by ensuring it replaces any proposed benchmarking solution in any bill Congress passes on this issue. I hope seniors and those who have loved ones will take a moment to call Senator Scott and tell him to address “Surprise Billing” and to do so in a way that protects both seniors’ pocketbooks and their access to care.

Conwell Hooper is the Executive Director of the American Senior Alliance.


%d bloggers like this: