Ban balance billing: Make health care more equitable

Illustration of a set of scales, with expensive medication weighing down one side while a patient looks at it with worry
Lucy Yang/Staff

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Even before the COVID-19 pandemic, approximately 1 in 6 emergency visits and hospital stays had an out-of-network charge, not covered by the patient’s insurance. And who are the ones left to pay the difference between how much the provider charges and how much the insurance pays? Patients. These costs are known as balance bills.

But the current raging pandemic has pushed hospitals to reach their maximum capacities, resulting in patients being transferred to other hospitals, which may not necessarily be in-network. Because these services are not in-network, patients’ health insurance policies may not pay their full charges.

What is despicable about balance billing is that patients are exploited when they are at their most vulnerable. In emergency situations, patients need immediate care. In possibly life-or-death situations, options are limited. Whatever is necessary to keep the patient alive is used, even if it is costly. When their lives are at stake, patients may not be in a state to think of the financial consequences until after they are released from the hospital and receive a medical bill charging them tens of thousands of dollars.

Even if patients are admitted into an in-network hospital, they may be assigned out-of-network providers. The six types of specialists who are most likely to send out-of-network bills include anesthesiologists, pathologists and emergency physicians. The common feature among these specialties is that patients typically do not choose these doctors themselves. For example, patients select their surgeons but not the anesthesiologists, radiologists, pathologists or assistant surgeons helping them. In a way, patients are set up to receive exorbitant medical bills by being unknowingly assigned out-of-network providers.

One might argue that balance billing promotes health care by incentivizing physicians to provide higher-quality care for patients. If patients are paying more, that must mean their care providers are working harder. But in reality, a higher profit for the physician really just means a higher cost for the patient.

In the United States, nearly 1 in 4 Americans avoid seeking medical care because of cost. And as these costs continually skyrocket, so will the number of Americans forgoing health care. Amid this growing issue, balance billing scarcely mitigates the financial burden for patients. So on the contrary, balance billing does not promote health care. Rather, it distances health care for people who cannot afford it.

By banning balance billing from out-of-network providers, we can achieve health equity for all Americans. One long-term effect would be that people in need would be able to actively seek medical attention without having to worry about balance bills. This is especially important for patients with private insurance because they are susceptible to being charged high out-of-pocket expenditures if they receive care from out-of-network providers.

Medicare beneficiaries, on the other hand, cannot be balance-billed if their provider accepts Medicare. Even if their provider does not accept Medicare, the amount it can balance-bill cannot exceed 15% of what Medicare would pay. But while Medicare patients are protected financially, they still face the indirect effects of balance billing. For example, physicians are incentivized to save costs by reducing the quality of care Medicare patients receive. Such discrimination does not belong in our health care system. By eliminating balance billing, we also eliminate this discrimination in pricing and quality.

Even the short-term effects of eliminating balance billing can provide lasting impacts for patients. Banning balance bills would encourage patients to seek treatment before their conditions worsen. Receiving preventative care or early treatment can save patients from more expensive procedures, medications and treatments. More importantly, it can save their lives.

This phenomenon is pervasive in our current public health situation. The Department of Health and Human Services recently prohibited providers from seeking out-of-pocket payments from confirmed and potential COVID-19 patients beyond the amount they would be expected to pay for an in-network provider. I hope this statement will be expanded beyond just COVID-19 patients to all patients who are in need of accessible and affordable health care.

Possible and confirmed COVID-19 patients can get the necessary treatment and testing without overwhelming financial concerns. Early detection can help reduce the spread of COVID-19. But this help is only provided if patients seek it. And patients will undoubtedly be more willing to seek help if they do not have to worry about whether their provider is out-of-network or in-network, whether the medical costs are expensive or inexpensive and whether their money or their life is more important.

Shawn Tran is a rising senior at UC Berkeley studying public health.