The battle is generally between independent doctors who work on contract in hospitals and insurance companies that are supposed to pay them. Sometimes they can’t agree on pricing contracts. Then patients walk into a hospital in network, not realizing they may see a doctor there who’s out of network. And they get socked with an out-of-network bill as a result.
"That's unfortunate for the patient," said state Sen. Ben Watson, R-Savannah, the chairman of the Senate Health and Human Services Committee. "There were so many things going on with health care that I think that got lost in the shuffle."
The real problem is that legislators are uncomfortable wading in between insurers and doctors. “They’re coming to the Legislature to ask us what’s the correct amount for billing, and that’s not really fair,” said Watson, who is a physician.
Watson's predecessor as head of the health panel, state Sen. Renee Unterman, R-Buford, also told her committee at one point that she'd done everything she could to get the two to agree, but they just don't. This year, Chairman Richard Smith of the House Insurance Committee said it would be wrong to force the insurance companies to contract for prices they don't agree to.
Having no solution may result in massive hospital bills for properly insured patients. But it’s not the end of the world for the doctor, and certainly not for the insurance company.
In such a case, the doctor can bill far more than he or she would under an insurance contract, though whether he or she gets paid is another question. As for the insurer: It pays, or doesn’t, by its own rules. The unpaid balance then goes to the patient, who has almost no recourse.
Legislative proposals to stop it came forward in the Senate and the House again in 2019, including Senate Bill 56, House Bill 84 and House Bill 540. Some didn't satisfy the doctors. Some didn't satisfy the insurance companies. Nothing passed.
"Do I think the legislators who've been working on this legislation over the years have intention of passing a law that removes the problem of surprise medical bills for Georgia consumers?" asked Liz Coyle, the director of the public advocacy group Georgia Watch. "Absolutely.
“But why is it that these powerful interest groups are being allowed to continue saying, ‘Well, we can’t come up with a compromise so I guess Georgians will have to stay stuck in the middle?’ That’s why we have a Legislature.”
Watson says that the insurers and the doctors ought to agree on their own and not ask the Legislature to set prices. Both he and Smith said it may be up to Congress to solve it. However, they added, they would continue to work on it.
If your doctor or your kid’s doctor did something bad, can you know?
The Georgia Composite Medical Board disciplines doctors and publishes that information in physician profiles on its website. Every doctor has one.
But not everything bad that the board knows is reported there. If Gov. Brian Kemp signs the 2019 Legislature’s bills into law, the public will be able to see even less.
And one important gap highlighted by reporting in the AJC was again left unaddressed: whether the medical board reports to police allegations of sexual assault by patients against doctors. The AJC reported on physician sexual misconduct and state boards' failure to stop such doctors in 2016, 2017 and 2018.
The board says it reports allegations to police when merited. But it has the right to deal with such allegations in secret and not report them to law enforcement.
That doesn’t mean the 2019 Legislature let the issue of medical licenses get lost in the shuffle; far from it. It made things easier for doctors.
With Senate Bill 16 the Legislature greenlighted Georgia joining the Interstate Medical Licensure Compact, meaning that a license from a state with weaker doctor discipline practices would be legal in Georgia as long as the other state meets the compact's standards.
With House Bill 551, it weakened a provision of law meant to identify doctors who overprescribe opioids by tracking them and their prescriptions. If a doctor is trying to avoid scrutiny and fails to register for the Prescription Drug Monitoring Program, the board would no longer be allowed to impose public discipline for not registering.
In general, legislators say they’re trying to encourage more doctors to practice here to address rural Georgia’s critical doctor shortage. Legislators who supported the HB 551 change said they were trying to give relief to new doctors and others who mistakenly got caught up in the new registration requirement and wound up with disciplinary records that could harm their careers.
Legislation also passed regarding what malpractice claims against doctors must be made public.
Georgia has a complicated formula that ensures no doctor's reputation will be blemished by one small malpractice settlement. A doctor must report settlements publicly only if he or she has had four ore more settlements; if the doctor had a settlement over $300,000; or if he or she had three settlements with one being over $100,000. Under House Bill 128, the number of settlements would not be pushed over the line by doctors who strike a type of settlement that includes paying something but also going to trial to see what the jury says, provided a jury clears the defendant.
State Rep. Deborah Silcox, R-Atlanta, said her priority in sponsoring HB 128 was helping doctors cleared by juries avoid being tarnished. She didn't think the absence of a bill requiring the medical board to report abuse allegations to police was a deliberate omission by the General Assembly.
Coyle, however, said both reporting requirements and surprise billing should be a priority. “Those issues really do matter,” she said.
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