Sunday, March 15, 2020

OCPA column: Oklahomans deserve protection from scam medical bills


Oklahomans deserve protection from scam medical bills
By Jonathan Small

Because hospitals operate in a system with little pricing transparency, many patient bills are more fiction than fact, yet patients can face financial devastation if they don’t pony up.

At the same time, the cost of medical bills would have been much, much lower if the market allowed for competitive pricing through up-front information.

This happens nowhere else in American society. Can you imagine purchasing anything—from goods at Walmart or Amazon to a car or home—without advance knowledge of price while facing a legal obligation to pay whatever a provider demands? Of course not, yet that scenario plays out in health care every day—even though most health care procedures are neither new nor emergencies.

Oklahomans deserve protection from these exploitive practices, and it’s to their credit that some lawmakers have filed legislation this year to protect consumers from “surprise” medical bills.

The proposed law would prohibit medical providers from reporting a healthcare debt to a credit bureau or pursuing collection activities unless the patient “was presented with and agreed to the total cost of all healthcare services” prior to receiving services.

Prior authorization is crucial, because many hospitals do much to keep patients in the dark. Even at medical facilities listed as “in network” on an individual’s insurance policy, specific doctors at that same facility can be considered “out of network,” such as an anesthesiologist. That’s often done deliberately and allows issuance of wildly inflated bills to patients given no forewarning.

Hospitals respond by quibbling over the definition of “surprise medical bill.” But I have a news flash: Any bill where a consumer is not provided an advance cost estimate is a surprise bill.

Oklahoma Watch has reported that dozens of Oklahoma hospitals filed at least 22,250 lawsuits against former patients over unpaid medical bills in recent years. Many of those bills fall into the “surprise” category, and those being sued include people from all parts of society, including people with insurance and those on government-funded Medicaid.

Some hospital officials suggest inflated bills are caused by “uncompensated care.” Yet that category itself is rife with bogus figures, as can be seen by hospitals’ actual profit margin. Oklahoma Watch found the Saint Francis Health System accounted for 22 percent of all state hospital lawsuits against patients. But when the 1889 Institute reviewed hospitals’ publicly available reported financial data in 2017, it found Saint Francis enjoyed a 17.5-percent profit margin.

U.S. House Speaker Nancy Pelosi famously said Congress had to pass Obamacare so citizens could find out what’s in it. For too long, Oklahoma’s big-box hospitals have operated on the Pelosi principle when it comes to medical bills. Lawmakers should put an end to that.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

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