LOUISVILLE, Ky - Medical costs continue to skyrocket in the United States including in Kentucky.

At times patients can receive astronomical bills from a medical emergency, these bills are categorized as surprise medical bills.

“When insurance companies don’t have enough of a particular specialist or specialty represented, patients may go to a hospital and see someone who is not in their network and they are surprised when they get a very large bill for that out-of-network care,” explained Dr. Robert Couch, an emergency physician in Louisville, and Secretary-Treasurer of the Kentucky Medical Association.

This is something that every American could have to deal with although it may not be as often as you think, Dr. Couch says. Typically, when an appointment is set up ahead of time the patient is aware of extra costs that could occur — it’s when an emergency visit must happen that people begin to be hit with out-of-network billing.

Congress is working on a solution to end surprise billing and various proposals are floating around in our nation’s capital. The Kentucky Medical Association is supporting the STOP Surprise Medical Bills Act sponsored by U.S. Senator Bill Cassidy, R-LA.

“The important thing in all of these solutions is to keep patients out of the middle,” said Dr. Couch. “Some of the proposals in Congress have features that would still keep the patients involved and exposed in some of these reimbursement plans.”

The STOP Surprise Medical Bills Act would offset the costs to the hospitals and providers by using a system called independent dispute resolution, which is a form of arbitration.

“This takes the patient out of the middle and this arbitration process would allow fairness to both the insurance and the physician and hospital provider,” said Dr. Couch.

According to Dr. Couch, this is beneficial for patients because it requires the insurance company and the hospital to reach an agreement on the out-of-network cost without involving the patient.  The state of New York has been using a similar law for several years.  A Georgetown University study found the law has been working in the state.

“They found that about a third of the time the process favored the insurance company, and about a third of the time it favored the provider and about a third of the time, the dispute was settled before it ever went to arbitration,” Dr. Couch said. “So it’s a way to save money and healthcare costs.”

The other proposals floating around Congress are untested Dr. Couch says.

“This idea of paying the median in-network rate has never been done before,” he said. “We have to be careful about the unintended consequences. Many practices, particularly in rural areas, are operating near the edge anyway, so anything that further compromise them financially could drive them out of practice and that’s the last thing we want.”

The STOP Surprise Medical Bills Act has been making its way through the Senate but its companion bill is taking more time working its way through the House.

“On the House side I think they are being a little bit more deliberative and so hopefully we can slow the process down a little bit to make sure we get the right solution,” said Dr. Couch. “My fear is the unintended consequences that could be out there that could cause more harm than good.”

Couch says it’s important to make sure any changes are made with patients in mind.

“I would like to see a solution that allows insurance companies develop adequate networks for care,” he said. “We don’t want to narrow the network, we want to broaden the network so as many people have access to healthcare as possible.”