Surprise medical billing legislation passes in Georgia House

(PHOTO contributed by Atrium Medical Center)

(PHOTO contributed by Atrium Medical Center)

Two bills that would put checks on unexpected medical bills passed the Georgia House of Representatives on Tuesday.

Surprise billing legislation narrowly failed in the House last year, with a vote of 77 to 78 on House Bill 84. The two bills that passed Tuesday with only a handful of "no" votes marked a key moment in a long effort on the issue by legislators, said Rep. Lee Hawkins, R-Gainesville.

"We've been fighting, or discussing, this bill for five years," Hawkins said of House Bill 888, which he sponsored.

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The bill, which passed 164-4, is intended to prevent people from receiving high hospital bills when they’re unknowingly treated by out-of-network doctors in an emergency situation. If a patient is rushed to the emergency room for surgery, they may not know what kind of insurance the anesthesiologist that’s putting them under takes until they get a bill. HB 888 would require patients to pay no more than their deductible, copay or other in-network payment level determined by their plan.

Providers can request arbitration for additional payment through the state insurance commissioner under this bill. Significantly, at that point the patient is out of the fight once he or she has paid their deductible or co-pay. Only the care provider and health insurance company remain in the dispute.

Rep. Renitta Shannon, D-Decatur, criticized the bill for not covering non-emergency situations in which a patient may not know one of their doctors isn’t covered by their insurance.

“What if you go for a colonoscopy and the anesthesiologist the hospital chooses is out of network?” Shannon said. She was one of the four “no” votes on the bill.

House Bill 789 helps patients check which doctors in the four most common specialties — anesthesiology, pathology, radiology and emergency medicine — will be covered by their insurance. The legislation would require insurance companies to keep an online directory of these specialists and mark whether each doctor accepts their insurance plan.

If signed into law, the bill would go into effect in October, allowing the ratings to be posted before health insurance open enrollment begins. That will put a “spotlight” on the changes and encourage compliance, said Rep. Mark Newton, R-Augusta, the bill’s sponsor.

“Everybody involved — the insurance companies who has the finances and the patients, the hospital for whom the patients are very valuable, and the providers — have an interest in having the very best rating,” Newton said.

HB 789 passed 170-1.

Staff writer Ariel Hart contributed to this story