The Problem with Price: Controversies and Solutions (2021)-R6-CNPM24-2021

Video Transcription

Video Summary

The video presents a session on "surprise medical billing," a concern in the American healthcare system. Pediatric radiologist Richard Heller explains that surprise medical billing or the "insurance gap" occurs when insured patients unexpectedly receive care from out-of-network providers, resulting in higher costs. The session discusses the necessity of legislation to address this issue, highlighting that bills should protect patients and prevent insurance companies from leveraging negotiations to drive down provider rates. The recently established No Surprises Act aims to eliminate surprise billing by ensuring patients' financial protection when they unknowingly receive out-of-network care, especially in emergency settings. The Act encompasses federal measures for ERISA plans and sets a process for independent dispute resolution, while also ensuring patient disclosure and good faith estimates. Concerns arise that while the Act protects patients, it could narrow in-network provider access, affecting long-established patient-provider relationships. The session underscores a need for a balanced approach that does not favor insurers or providers unfairly while ensuring patient protection remains central.

Keywords

surprise medical billing

American healthcare

insurance gap

No Surprises Act

out-of-network care

independent dispute resolution

patient protection

healthcare legislation