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ER doctors: We need to protect patients from surprise medical bills

  • Author: Ben Shelton
    | Opinion
    , Anne Zink
    | Opinion
  • Updated: June 20, 2018
  • Published June 20, 2018

As emergency medicine doctors caring for patients in Alaska, we treat members of our community every day who are severely injured or ill and are fighting for their lives. But recently, we've been working double shifts at the state capitol, to save an important consumer protection rule and clear up the facts when it comes to Alaska emergency care and the 80th-percentile rule.

Right now, Alaska's largest insurance plan company is actively spreading falsehoods in the capitol, confusing patients and lawmakers and leading a campaign to turn back the clock on emergency care we've fought so hard to improve. Alaska's patients and families literally cannot afford to fall for this nonsense.

Although Alaska's largest insurer made more than $38 million in profits and received $55 million from the Alaska government last year, Alaskans are paying more in health care premiums and out-of-pocket costs, and 17 percent have medical debt in collections.

The 80th-percentile rule is a patient protection measure that requires your insurance company to pay fair rates for emergency care, even if you unexpectedly see an out-of-network doctor or specialist. It protects patients from denials of coverage and the huge bills that follow. Importantly, it helps ensure Alaska's fragile emergency care system stays open and ready to treat patients. Insurers pay out-of-network providers directly at a rate determined by the 80th percentile of local market charges for that service. It's a standard that the National Conference of Insurance Legislators has endorsed and that other states have put in place. We are laying out the facts here to set the record straight.

There is absolutely no evidence that the 80th percentile rule raises costs. Since implementing in their states, New York and Connecticut have seen costs stay the same or even decline for some services. In Alaska, a study was recently conducted to get at the issue, but the results are not conclusive, and we support continuing to get better information on this important issue.

Alaskans are paying more for health insurance, while insurers see record profits. Insurers are shifting costs to patients through higher premiums, deductibles, copayments and coinsurance, then cutting back on what they cover and how much they pay for services and pocketing the difference. Alaska's insurance premium rates are consistently among the highest in the country, but that money is not all going toward actual health care costs. Twenty-five percent of insurance costs off the top go to insurance company profits and brokers. In 2017, Premera actually made more than the legal 20 percent profits and had to return funds to the state. Those profits don't take into account the $2.28 million salary of Premera's Alaska CEO. At the same time, 5 percent of costs off the top go to insurance brokers.

Emergency doctors in Alaska do not charge more for services than anywhere else in the country. The cost billed for emergency services in Alaska are the same as or even less than Seattle. For a very sick, complex patent seen in an emergency department in Anchorage, the 80th-percentile charge is $1,021, while Seattle's is $1,129, and in New Orleans, this same charge runs at $1,924.

The number of in-network physicians is growing in Alaska. Since the 80th-percentile rule was introduced, networks of providers have become more inclusive and grown larger, not smaller. Last year, Premera added more than 100 providers to their network.

Because of fair payment, we have been able to build access to critical health care services. Alaska now has a robust statewide trauma system and two trauma centers that did not exist 10 years ago, but our system is fragile and we still have a long way to go.

Although we have made great strides in increasing the number of specialty physicians in the state, Alaska still does not have a burn unit, 24/7 cardiothoracic surgery, or an interventional neurosurgeon who can coil a brain aneurysm. We routinely have to transfer patients to Seattle at an incredible emotional and financial cost. Patients sometimes die as a result of the delay to definitive care. Without the 80th-percentile rule, unpaid emergency bills will restrict access to emergency care, particularly specialty care, and we will lose the gains we've made.

During the recent legislative session, two bills would have handled this issue very differently. SB 129 would have dismantled the 80th-percentile patient protection rule and put our emergency health care system at risk. House Bill 193 would have protected patients from surprise bills and maintained access to care by codifying the 80th-percentile rule into law for emergency care.

Alaskans deserve to have access to emergency care and to have their insurance plans work, especially in an emergency. Next year, the Legislature should advance a solution like HB 193, to protect Alaska's patients, families and emergency care system.

Ben Shelton is an emergency doctor practicing in Anchorage. He serves as the president of the Alaska Chapter of the American College of Emergency Physicians.

Anne Zink is an emergency doctor practicing in Palmer, Alaska. She is the immediate past president of the Alaska Chapter of the American College of Emergency Physicians.

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