Congress must end surprise billing — in a fair and reasonable way | Guest editorial

The state Legislature recently passed an act that eliminates protects patients from surprise medical billing.

  • Monday, January 6, 2020 9:28am
  • Opinion

By Dr. Sean Kincaid

Special to the Reporter

One of the foremost goals of any physician anesthesiologist is to ensure the most positive, painless patient experience possible. However, there is only so much we can do to protect patients from the pain of getting hit with high, unexpected medical bills demanding payment for the cost of care they assumed would be covered by insurance.

Fortunately, the Washington Legislature passed the Balance Billing Protection Act, based on input and compromise by providers, insurers, the insurance commissioner and other stakeholders. It eliminates this practice and protects patients from surprise medical billing. However, too many patients nationwide remain vulnerable — as do Washington patients if they are treated outside our state’s borders. That is why it is vital that Congress pass a federal solution to end surprise medical billing nationally.

As they continue to hammer out such a solution, lawmakers in Washington, D.C. must be careful to leverage a fair, workable approach for all parties involved. That means avoiding a particularly harmful proposal known as benchmarking, which could undermine access and affordability for patients while failing to address one of the key contributors to this problem: inadequate provider networks.

Whatever legislative solution Congress passes must not only hold patients harmless for unexpected medical bills, but also ensure adequate network standards so these insurance gaps never happen in the first place. A solution that has been proposed in Congress, called Independent Dispute Resolution (IDR), would achieve both of these goals.

As the basis for Washington’s state law, the IDR process would allow physicians and insurance companies to negotiate out-of-network billing disputes among themselves, removing patients from the process. Each “side” would submit their payment offers through a simple, online platform and an ultimate decision as to the final amount would be determined by a third-party, independent mediator who would ensure payments are fair, accurate, and based on the true cost of providing clinical care.

What’s more, an IDR-based approach would incentivize insurers to engage in fair contract negotiations with physicians, helping to strengthen network adequacy and grow, rather than continue to shrink, provider networks. This is also the approach that has been working well in New York since 2015, when state legislators passed a strong, IDR-focused solution there. Since then, in-network participation is up, out-of-network billing is down and emergency care costs have also dropped.

This is a vastly better solution than another proposal that Congress is considering, known as benchmarking. Under a benchmarking approach, the government would set inordinately low out-of-network rates for physicians, which would shift enormous losses onto hospitals and emergency rooms. For many of our state’s at-risk health care facilities serving rural, hard-to-reach, or otherwise under-served communities, a benchmarking solution could jeopardize patient access to care while driving costs up.

Sen. Patty Murray, who has cosponsored a benchmarking-based proposal, should reconsider this flawed approach and work to replace it with the far more effective and equitable IDR process. Ultimately, this is best solution to protect all patients from surprise medical billing while strengthening network adequacy and preserving vital access to rural health care.

Dr. Sean Kincaid is the president of medical staff at EvergreenHealth in Kirkland. He has served on the board of the Washington State Society of Anesthesiology, in positions including treasurer, secretary, vice president, and president, as well as in the role of delegate to the American Society of Anesthesiologists.

In consideration of how we voice our opinions in the modern world, we’ve closed comments on our websites. We value the opinions of our readers and we encourage you to keep the conversation going.

Please feel free to share your story tips by emailing

To share your opinion for publication, submit a letter through our website Include your name, address and daytime phone number. (We’ll only publish your name and hometown.) We reserve the right to edit letters, but if you keep yours to 300 words or less, we won’t ask you to shorten it.

More in Opinion

Cartoon by Frank Shiers
Editorial: Stopping COVID is now up to each of us

With a resurgence threatening, we need to take greater responsibility to keep the virus in check.

Back to the wild — a whole new outdoor recreation world | Guest editorial

When enjoying the great outdoors, continue to socially distance and be aware of how else COVID-19 has changed our world.

We are all in this together | Coming of age…again

How can we, as neighbors, help each other?

Earth Month 2020 and COVID-19: Caring for the planet and each other

Here are some ways to minimize your carbon footprint and protect the planet amid the pandemic.

KCLS is stepping up its commitment to patrons

KCLS has expanding its online resources so patrons can continue to learn, build skills, stay entertained and remain mentally and physically active amid the pandemic.

The true meaning of community | Guest editorial

LWTech president Dr. Amy Morrison reflects on how the COVID-19 outbreak has brought the community together.

Deserving respect for being human | Windows and Mirrors

Since the COVID-19 outbreak began, Asians and Asian Americans have been targeted. Here’s what’s been happening on the Eastside.

Thank you grocery store clerks

Recognizing the sacrifices of our unsung essential workforce.

Now is the time to be kind to each other | Windows and Mirrors

As the COVID-19 outbreak continues, it is important for us to be there for others in our communities.

To our elected officials: Be bold, be consistent, be honest, be helpful

By Patrick Grubb, Washington Newspaper Publishers Association Governor Jay Inslee has been… Continue reading

Libraries are the place to go according to poll

Library will host short film festival on March 20.

A way to keep us healthy | Letter

A problem has occurred recently that I would like to address. On… Continue reading