The type of surprise billing at issue happens when a properly insured patient goes to an emergency room. The caregivers there are obligated to treat the patient. But some of the doctors, such as anesthesiologists or radiologists, may not be hospital employees; they may be independent contractors. And they may not have been able to agree on a contract with that patient’s insurance company, meaning they are out of its network.
If a doctor is out-of-network, the insurance company may pay the patient’s hospital facility charges but refuse to pay the doctor’s bill, or pay a tiny amount. That leaves the doctor free to bill the patient for the balance.
Each bill can easily run in the hundreds or thousands of dollars. Doctors hate it, too, because many patients don’t pay such big bills.
The sticking point between the two groups at the table — doctors and insurance companies — is how much to pay for any given medical service.
The insurance companies say doctors are asking for too much money. The doctors have suggested the payment rates be based off a database of paid charges.
A lobbyist for Georgia health plans, Jesse Weathington, read a list of the charges doctors have billed compared with the amount Medicare pays or that some plans have contracted for. The difference was significant.
Doctors say that’s the problem: Medicare pays less than even the cost of giving care, and insurance companies are lowering rates so much that doctors are having to drop out of network.
A lobbyist for the doctors’ group the Medical Association of Georgia, Derek Norton, said that the insurers rejected the doctors’ database proposal but didn’t respond with a concrete proposal of their own.
Taylor also said she has concerns about the database SB 56 would use. She works in the insurance industry, and she says she’s seen how doctors raise their prices “when you just open the faucet.” She’d prefer making the price some multiple of Medicare rates.
Smith had his own proposal, House Bill 84, but it failed in the House by one vote. It would not have mandated that insurance companies and doctors settle the final bill between themselves.
The Legislature has been stuck on the issue for four years. Taylor said she, too, has been the victim of surprise billing and wants to end it.
“It’s something we have to address. We have to find a way to do it,” she said. “I do think we’ll find a way. It may not be today or tomorrow. … It’s a rush right now. There just aren’t enough hours in a day.”
Stay on top of what’s happening in Georgia government and politics at ajc.com/news/georgia-government/.