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Emergency bill surgery: A state law protecting patients from surprise medical charges is a big success; replicate it


Every now and then, legislators in New York set a major policy precedent, and it works. To that too-short but important list add a 2015 attack on surprise medical bills.

Congress should take note and follow suit.

The problem is known to just about anyone who’s ever gone to the emergency room. Insurance, which already costs an arm and a leg, is supposed to cover major costs. But unbeknownst to the patient at the time, a specialist or anesthesiologist or other member of a medical team called into handle some job or another is out of network — resulting in an out-of-the-blue cost tens of thousands of dollars in excess of what was expected.

That’s the way things worked in New York six years ago, anyway, and it remains the norm across the country.

So the state, urged by then-Superintendent of Financial Services Ben Lawsky and Gov. Cuomo, took action, requiring neutral and binding arbitration, called independent dispute resolution, between doctors and insurance companies to settle payment fights. Patients are held harmless.

A 2018 working paper by Yale economists found that out-of-network bills went down 34% after the law took effect. A report by the state released last week tallied a total of 2,595 decisions rendered through the new process. All told, they’ve saved consumers more than $400 million.

There’s bipartisan support in Congress for following New York’s lead; President Trump has signaled support. Sadly, the biggest surprise of all would be Democrats and Republicans diligently crafting a national solution and getting it to the president’s desk.