Effort to tamp down surprise ER bills faces trouble in Georgia House


The Georgia Legislature appears set to go another year without passing legislation addressing surprise billing, leaving Georgia hospital patients to face potentially thousands of dollars in unexpected doctor bills.

Senate Bill 56, a proposal that aims to protect properly insured patients who go to emergency rooms from receiving additional surprise doctor bills after the fact, was debated Thursday before a Georgia House Insurance subcommittee. But the panel ended its meeting without taking a vote. Its chairwoman, state Rep. Darlene Taylor, R-Thomasville, said she didn't know whether she'd be able to find the time or schedule a room by the end of the legislative session to take a vote.

“It’s disappointing that consumers will be left in the same situation that they’ve been in for years now,” said Laura Colbert, the director of the patient advocacy group Georgians for a Healthy Future. “On the hook for surprise medical bills that they had no control over and that can have a big impact on their financial health.”

Taylor, the chairwoman of the subcommittee, deferred to the chairman of the Insurance Committee, state Rep. Richard Smith, R-Columbus, saying she'd have to coordinate with him. Pressed on whether the bill's iffy prospects for a vote were a matter of will or a matter of time, Taylor said, "I'm really not sure."

Smith has made his opposition clear. Addressing the entire House on March 7, Crossover Day, he told the sponsor of SB 56 that his bill could be heard, but "we will have a hearing and a hearing only."

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/.

About the Author