Congress: End Surprise Billing While Protecting Colorado Seniors

By Ken Jenson, Owner
Amada Senior Care ~

For seniors, accessing the healthcare services and treatments on which they rely can be an overwhelming task fraught with obstacles ranging from mobility and transportation issues to fixed incomes and high prescription drug costs—among many others. That is part of the reason I launched Amada Senior Care to provide superior quality home healthcare for Colorado’s seniors.

Currently, Congress is working on an issue that impacts all patients, seniors included, called surprise medical billing. Generally, surprise medical billing happens when a patient receives emergency care and is treated at an out-of-network facility or by an out-of-network physician, and then—weeks or months later—is hit with high, unexpected medical bills requiring payment for the cost of care not covered by their insurance plans.

Even seniors on Medicare can be caught off-guard by surprise bills in cases where they are taken in for treatment and not admitted for three days or more. In these instances, my clients essentially become out-of-network emergency cases—meaning they can get saddled with hundreds or thousands of dollars in bills that they simply cannot afford. The emotional and financial devastation this causes is unconscionable; my team and I have seen vulnerable patients and their families torn apart by this unfair billing practice too many times.

For that reason, I am glad to see Congress has started working on solutions to this problem. As summer comes to a close and legislators return to Washington, D.C., for Congress to get back into session, they must redouble their efforts and help pass a viable solution to this problem that will protect seniors and all patients.

However, I worry that some of the solutions currently on the table would only make a bad situation worse, particularly for seniors. Some bills in Congress, including the Lower Health Care Costs Act, would implement a “benchmarking” solution to end surprise medical billing. Essentially, benchmarking would lead to a form of government price controls whereby the U.S. government would set payment rates for physicians.

This kind of approach would end up slashing reimbursements to providers, transferring huge losses to local hospitals and emergency rooms. Many of these facilities are struggling just to stay open as it is—this form of government rate-setting could push them to scale back services, ration care, consolidate, or even close down altogether. Any of these options would simply make it that much harder for patients to access the care they need. For seniors that already face so many barriers to care, the outcome could be detrimental.

Instead of undermining access for seniors in Colorado and across the country, Congress should pass a legislative solution that eliminates surprise billing in a more responsible way. Legislation like the STOP Surprise Medical Bills Act, which was co-authored by Colorado’s own Senator Michael Bennet, offers just such a solution by using a process known as Independent Dispute Resolution (IDR).

Instead of relying on government rate-setting, the IDR process would allow doctors and insurance companies to negotiate out-of-network payment rates on an individual, case-by-case basis. A neutral, independent mediator would determine a final payment based on the true market value of the services provided. In the meantime, an interim payment would help protect at-risk hospitals—including those in remote, rural areas—from incurring financial losses that could undermine access or quality for patients.

Ultimately, IDR is the best approach and I commend Senator Bennet for working to advance this solution. The rest of his colleagues—both from Colorado and throughout the nation—should support the IDR process and work to include it in a final bill passed by Congress. Colorado seniors are counting on it.

Ken Jenson is the owner of Amada Senior Care, which provides in-home care for seniors throughout in the Denver and Colorado Springs region.