A column by Chattanooga emergency physician Dr. Andy Walker (“Let’s Put an End to Surprise Medical Bills”) addressed surprise billing, a topic that’s made headlines across the country. BlueCross BlueShield of Tennessee agrees we have to resolve this issue on behalf of Tennesseans, but Dr. Walker’s column did not accurately diagnose the problem and contained misleading assertions about benchmarking, a market-based solution that could serve our neighbors well.
To work together and fix surprise billing, we need to examine the root cause of the problem.
Surprise billing is a type of balance billing, so let’s start there. Balance billing happens when an out-of-network provider chooses to bill a member for the difference between their “list price” and what BlueCross pays for the services provided.
Surprise billing, then, is even more problematic. It happens when a member uses an in-network facility and receives services from an out-of-network provider who then sends an unexpected balance bill.
Providers don’t have to send balance – or surprise – bills to their patients. It’s their choice, and we’ll take a closer look at that in a moment.