Patients over profits: Arizona must act on medical billing reform

Health care is a critical aspect of life for Americans and Arizonans alike. For physicians like myself, it is not only our livelihood — it is our passion and our life’s purpose. The need for health care unites us all, and COVID-19 brought the necessity of a quality health care system into sharp focus. 

One element of our health care system that has received national attention is medical billing. Anyone who has ever dealt with a surprise medical bill due to the denial of payment from an insurance company knows this issue all too well. 

As it stands, insurance companies have too much power to deny claims and withhold payments. Claims submitted by health care providers are commonly denied by insurance companies without explanation. The medical billing process is complex and confusing for both patients and providers, and the insurance companies are benefiting from this. 

All too frequently, patients are stuck with the bill.

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

Now, the bad news: The process of implementing the law was hijacked by the healthcare insurance industry and its lobbyists. The result clearly flies in the face of congressional intent. The No Surprises Act has been sliced and diced with special loopholes, benefiting insurers at the expense of patients and health care providers.

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

Across the health care community, the current medical billing process is an issue that requires urgent attention. The Arizona Medical Association (ArMA), the largest physician-led organization in the state, will ensure that it is addressed.

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

Our view is this: Our community expects its leaders to work together, find common ground, and deliver solutions to the challenges it faces. ArMA is committed to fulfilling this leadership responsibility on behalf of patients and physicians. We are working diligently to reach a successful solution in Arizona.

And in doing so, we believe that: 

• Arizona should codify and strengthen the patient protections in the No Surprises Act 
• Oversight is 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 the dispute resolution is ongoing. This is the status quo, and it incentivizes insurers to drag out negotiations and withhold legitimate payments 
• Payers should not operate hidden profit arrangements — in which they underpay clinicians and retain the underpayment as their own profit stream — raising healthcare costs for employers and patients 
• Transparency into the role of insurance in healthcare costs and administrative burden is needed. 

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