At panel convened by Rep. Davids, experts discuss reasons behind surprise medical bills

Shalae Harris, program director of the Alzheimer’s Association Heart of America Chapter, speaking at Friday’s panel on surprise medical bills.

U.S. Rep. Sharice Davids went to the emergency room in her early 20s for an x-ray of her nose, but cut the visit off when she realized she was being taken in for a CT scan. The difference in cost between the two procedures is thousands of dollars, and she didn’t have insurance at the time, she said.

Davids’ fears about getting a medical bill she wasn’t expecting are a common experience, she said Friday at a roundtable discussion she convened at the Johnson County Library’s Central Resource Branch. One person was diagnosed with a rare form of cancer that required shots every so often. After the first shot was administered, the patient was shocked to get a $42,000 medical bill. Another person had a biopsy of a suspicious mass as a precaution, and ended up with a $5,000 surprise medical bill.

“These are the kinds of stories I feel like a lot of us have either experienced… or someone in their family or a loved one has,” Davids said. “It shows just how common and prevalent these kinds of issues are.”

Marc Larsen, emergency physician at Saint Luke’s and president of Metro Emergency Physicians, answers a discussion question posed by U.S. Rep. Sharice Davids.

The discussion Friday featured four panelists:

  • Lee Norman, secretary of the Kansas Department of Health and Environment
  • Marc Larsen, emergency physician at St. Luke’s and president of Metro Emergency Physicians
  • Shalae Harris, program director of the Alzheimer’s Association Heart of America Chapter
  • Sam Caughron, pathologist and lab medical director at Advent Health and president of MAWD Pathology Group

A surprise medical bill is simply a bill someone wasn’t expecting, the panelists said. The surprises come because it turns out either the patients weren’t covered for a certain medical service or they don’t realize the physician they went to see was out-of-network.

In some instances, the issue stems from legislation: The Emergency Medicine Treatment and Active Labor Act, for example, prohibits emergency physicians from discussing insurance or payment until after the physician has ruled out life threatening conditions.

“You buy your insurance, you pay your premiums, you think when you have a heart attack or when you have a stroke, that you’re going to have your care covered for you,” Larsen said. “Then you go to the emergency department and you find out you didn’t have a heart attack, you had reflux. You’re fine, but I [the physician] didn’t know that, I have to do the work until I come to that realization.”

Another contributing factor to the issue is when insurance companies low-ball physicians on the rate they are willing to pay for medical services. Some states like New York use arbitration as a way to get fair rates from insurance companies. With arbitration, a third party looks at two bills and decides which is a fair rate and that’s the bill that is sent to the patient. Davids has signed onto H.R. 3502, a bill to protect consumers against surprise billing, which includes the use of arbitration.

For those on Medicare who have been hit with a surprise medical bill and are looking for advice or help on handling it, Davids said to reach out to her office. Otherwise, those affected may consider negotiating their surprise medical bill or stretch out the payments, Norman said.

“It’s amazing how many people just think that they’re powerless,” Norman said. “You can work with the financial counselors at institutions or medical groups, and sometimes they’ll say, ‘Okay, let’s do something reasonable.’”