Chris Kinonen: Congress must establish insurance network standards, fair payment formulas

Dear Editor: You may have seen recent congressional activity on surprise medical billing. When presented with a patient specimen, I don’t wait in the laboratory to check the patient’s insurance. I run the right tests and review the slides at my microscope to diagnose disease. Billing occurs later. My colleagues and I support holding patients financially harmless from unexpected out-of-network bills. Physicians want to be in-network and accept insurance plans. Often, it’s the health insurer who drops physicians or refuses to contract with physicians.

Congress needs to adopt a federal legislative proposal that includes network adequacy standards requiring health plans to contract with the right numbers of physicians. Any legislative proposal should also ensure that insurers and providers can negotiate contracts equitably. Several proposals in Congress hand all the negotiating power to insurers. Congress should establish a fair payment formula for out-of-network physician care and use an arbitration process allowing a doctor and insurance company to settle a bill through a third-party process. Congress must take a serious look at the proposals by several physician members of Congress, led by Reps. Ruiz and Roe. Their proposal is a positive step in the right direction.