Surprise Medical Billing Hits Rural America

Time after time, each fight in Washington that pits hardworking Americans against insurance behemoths has a common ending: The insurers win, and we lose.

Now, the latest health care debate in Washington is centered around surprise medical billing. Surprise medical billing is when a patient receives a bill for the cost difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductible.

Of course, lobbyists for the insurance companies have shielded their companies from any responsibility in the ongoing scam. They spend millions of dollars on lobbying members of Congress, and now, in yet another debate, both parties are allowing big insurance companies to skate free of any responsibility in this mess.

As Washington tends to do, they pick an outlier in the medical industry and attack it, acting as if it is the source of most people’s problems. In the case of surprise medical bills, politicians have set their sights on air-ambulatory care.

Some call them life-flights, and it turns out being whisked from an accident site in rural America to a trauma center via aircraft is expensive. The costs of pilots, medical professionals, aircraft and infrastructure are expensive. According to the National Association of Insurance Commissioners, an average cost for one air-ambulance flight is between $12,000 and $25,000.

While these chopper rides may be the shiny and expensive object in the conversation, most Americans will thankfully never ride in one. Surprise medical bills hit most people in much smaller, more frequent quantities at the doctor’s office for testing and in traditional emergency room experiences.

The whole issue comes down to one basic observation of the medical industry: Insurance companies spend a heck of a lot more time finding ways to not cover the services patients need than finding ways to cover them.

In rural America, we are suffering from the rapid closure of rural hospitals. The geographical gap between many Americans and trauma centers continues to grow wider, impacting more people. About 85 million Americans have access to a level 1 or 2 trauma care facility within one hour only if they are airlifted.

Doctors will explain to you just how important being within an hour of a trauma center is if you are in an accident or have an incident like a massive heart attack. In the medical community, it is called the golden hour — and it is the difference in life or death in many trauma situations.

So here we are, another debate in Washington that sidesteps the real issue at hand, finds the scapegoat and avoids pointing fingers at the real perpetrator: the insurance industry.

With the closure of rural hospitals and the notion that we can simply video conference into our doctor appointment, rural Americans cannot sustain the hit of medical air transport becoming a luxury. That solution would totally miss the real issue at hand and put millions of Americans further and further away from the crucial emergency care they need. Any reform that hopes to decrease surprise medical billing must reign in the insurance industry. 


Chris Skorupa currently serves as vice president of the Rural & Agriculture Council of America, a consortium of mayors, county commissioners, ranchers, farmers, producers, main street business owners and leaders in rural America.

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