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Commentary

Recently, the health-care system in Nevada seemed to be causing as much pain as it was treating. For many Nevadans, an unpleasant hospital visit is made worse by the staggering costs of an unanticipated medical bill. Recently, though, lawmakers took a big step toward righting this wrong.

As an anesthesiologist and proud Nevadan, I applaud Gov. Steve Sisolak and state legislators for enacting a law that protects patients from surprise medical bills for emergency care. The stress of a medical emergency should not be compounded by the sticker shock of a surprise bill, but there is more to be done to ensure that patients are fully protected for all types of care.

Surprise bills are often the result of insurance companies’ failures to provide adequate coverage for out-of-network care. Most physicians are “in-network” when we work with specific insurers and accept a reduced reimbursement rate for our services. Each dollar of care provided corresponds with a negotiated per-dollar rate of reimbursement from insurers.

Insurance companies — generating record annual profits — are endangering patients by shrinking their coverage networks and expanding the insurance gaps responsible for surprise medical bills. Complicated jargon and the inherent unpredictability of health care means that even the savviest patient likely won’t know the network status of their doctor at every point of care, especially in a medical emergency.

The new law, Assembly Bill 469, takes patients out of the middle of emergency billing disputes so they can focus on what matters most — their health. In some cases, it also introduces a highly effective form of arbitration, which requires insurers and providers to submit their proposed prices for an out-of-network procedure to a neutral arbitrator who then selects one based on market rates.

These new regulations also defend patients with prudent layperson protection, which protects people who head to the hospital believing they are experiencing a medical emergency even if it’s later determined that their situation was less dire. So, if you go to the ER with chest pains but discover you were having a bad case of heartburn, you’ll likely be protected from picking up expensive out-of-network charges. This is critical because it ensures that no Nevadans will need to sacrifice their health for fear of not being able to cover the bill.

Once you leave the hospital, these new regulations also limit your payment to in-network fees for a co-pay, deductible or coinsurance. There are no loopholes that would subject you to expensive, unfair out-of-network fees. And in one to two years, the state will start evaluating how effectively the law is preventing surprise medical bills.

New York state has successfully implemented arbitration-style regulations for surprise billing, and the results have been remarkable. New York has seen its out-of-network emergency care billing rate fall from more than 20 percent to just 6.4 percent. With this new law — and hopefully, more patient protections on the horizon — Nevada could see a similar outcome.

Anesthesiologists spend their careers working with patients in the ER, so we’ve seen first-hand the devastating effects unexpected medical bills can have on patients who should be focusing on recovery. Future legislation must expand these protections to non-emergency medical care so that Nevadans don’t have to fear a surprise bill when they’re at their most vulnerable. It’s time for insurance companies to stop prioritizing profits over patient health and accept a reasonable solution that supports a better health-care system for all.

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Dean Polce, D.O., resides in Las Vegas.

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