As we continue to grapple with the rising cost of health care and health insurance, especially in rural states like Oklahoma, one of the most troubling aspects of this trend is the prevalence of hidden costs that are passed on to patients by insurance companies after they deny an out-of-network claim.

As you are no doubt aware, the economic challenges rural hospitals face are significant and growing, with high fixed costs and lower patient volumes relative to big city institutions, but with no corresponding difference in patient need and the delivery of care. The economic suffering — and the growing number of closures — of small, rural hospitals have been well documented. If, for any reason, more of our rural health care institutions are shuttered, it is unclear how and where many rural Oklahomans would access the hospital and emergency room services they need and rely upon. Moreover, a closure would also put, in many cases, the largest employers in rural areas out of business and many full- and part-time hospital employees out of work. High fixed costs coupled with older patients make these institutions hard to sustain over time. But these challenges are also exacerbated by government policies that have not addressed — surprise medical billing.

Imagine thinking you were going to an in-network provider, and many times there are no options in rural areas for multiple choices, just to be surprised by a medical bill that is way higher than you anticipated at the only doctor available for the medical issue — this is a huge burden in rural areas.

These charges often reflect services administered by third parties — such as lab tests — that are rejected by insurance. The hospital may be in-network, but the third-party provider working in the hospital is not. Surprise!

Imagine having a medical issue in Okemah and going to the new in-network hospital, and being told you need a lab test, only to have the cost rejected by insurance and billed at a big cost. Don’t expect any warning. Doctors should practice medicine, not be worrying about in-network and out-of-network costs.

To its credit, Congress is appropriately trying to wrestle with this issue. However, some of the current rate-setting proposals represent a legislative cure little better than the ailment. Put simply, these proposals would put doctors out of business and put rural health care in jeopardy. The consequences of these proposals are doctor shortages and institutional closures that would negatively impact the health of patients in the rural communities.

Any solution to the problem of surprise billing must put patients first, not insurers.

Yes, that means lowering costs — but it also means making sure patients can actually see doctors when the need arises.

It’s critical that Congress avoids current proposals that set reimbursement rates and lead to doctor shortages. Such shortages would hit rural communities, which already face access issues, especially hard.

The rate-setting and benchmarking proposals currently under consideration by Congress will put immense strain on rural hospitals already at risk of closing and will likely lead to doctor shortages in communities least able to afford them. At best, surprise billing creates an additional burden for patients who, while recovering from injuries or illnesses, must pay additional medical bills on top of already-high premiums and any co-pays or deductibles. Many Americans, who pay their monthly premiums and expect that their insurance will cover the cost of a medical emergency, are not in a position to shoulder such a burden.

I urge our Oklahoma delegation to reject any legislation that incorporates these approaches. Instead, please prioritize solutions that protect rural Americans’ access to health care and emergency room services by ensuring hospitals and doctors are fairly compensated for the critical services they provide.

Monica Miller is executive director of the Oklahoma Rural Association.

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Monica Miller is executive director of the Oklahoma Rural Association.