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Arizona must act on medical billing reform

Health care is an essential aspect of life for Americans and Arizonans. For physicians like me, it’s not just our livelihood, it’s our passion and our life’s purpose. The need for health care unites us all, and COVID-19 has highlighted the need for a quality health care system.

One element of our health care system that has received national attention is medical billing. Anyone who has ever had to deal with a surprise medical bill due to an insurance company refusing to pay knows this problem all too well.

As things stand, insurance companies have too much power to deny claims and withhold payments. Claims submitted by health care providers are usually denied by insurance companies without explanation. The medical billing process is complex and confusing for both patients and providers, and insurance companies are taking advantage of it.

Too often patients are stuck with the bill.

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However, there is good news: In a rare moment of bipartisanship last year, Congress passed a bill to clamp down on some of these issues. It was called the No Surprises Act and it was passed with overwhelming support from leaders on all sides. Doctors and insurers have come together. Republicans and Democrats have come together. All rallied around the lofty ideal of ending surprise medical bills.

Now the bad news: the law’s implementation process has been hijacked by the health insurance industry and its lobbyists. The result clearly defeats the intent of Congress. The No Surprises Act has been sliced ​​and diced with special loopholes, benefiting insurers at the expense of patients and healthcare providers.

In Arizona, there are good corporate citizens in the insurance market. But what happened to this law defies all logic. It has put insurance companies in the driver’s seat of health care, to the detriment of patients and the doctors who care for them. What was a bipartisan success story is now a national threat to patient care.

Throughout the healthcare community, the current medical billing process is an issue that requires urgent attention. The Arizona Medical Association (ArMA), the largest physician-run organization in the state, will ensure she is treated.

Earlier this year, we began forming a coalition to address these issues, with the goal of bringing solutions to voters via the ballot in 2022 or the Arizona State Legislature in 2023. , we heard directly from local representatives of the insurance industry, who asked to wait and work together on solutions. We made the decision to do so.

Our view is that our community expects its leaders to work together, find common ground, and come up with solutions to the challenges they face. ArMA is committed to fulfilling this leadership responsibility on behalf of patients and physicians. We are working diligently to achieve a successful solution in Arizona.

And in doing so, we believe that:

  • Arizona Should Codify and Strengthen Patient Protections in No Surprises Act
  • Oversight needed on claim denials with penalties for health insurers who abuse the denial process to enrich their profits
  • Health insurers should be prohibited from investing disputed payments while dispute resolution is pending. It’s the status quo, and it’s incentivizing insurers to drag out negotiations and withhold legitimate payments
  • Payers should not set up hidden profit making arrangements – in which they underpay clinicians and keep the underpayment as their own profit stream – driving up healthcare costs for employers and patients
  • Transparency about the role of insurance in health care costs and administrative burden is needed.

We will continue to work for reforms until the medical billing process reflects the honesty, transparency, and accountability that Arizona patients and physicians deserve. And if we are successful, our state can provide a national model of reform that will benefit patients and physicians everywhere.