Georgia Legislature takes aim at surprise billing, again

(PHOTO via Dreamstime/TNS)

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(PHOTO via Dreamstime/TNS)

Surprise billing continues to wallop hospital patients in Georgia. As in years past, the Legislature continues to say it wants to help.

Surprise billing happens when properly insured patients receive reasonable health care and then find out after the fact that their insurance company isn’t going to pay. The most commonly discussed occurrences are with doctors such as radiologists and anesthesiologists who work in hospitals.

Such doctors may be contractors rather than hospital employees, a practice that is increasingly common. If so, although the hospital may be in the patient’s network, that doesn’t mean the doctor is. If the doctor doesn’t have his or her own contract with the patient’s insurance company, there won’t be an agreed-upon price. In that case, the insurance company may pay the doctor little or nothing — whatever it decides. And the doctor will bill the patient for the rest — whatever price the doctor decides.

The patient is in the middle, stuck with a bill he or she didn’t expect and is probably a sky-high price to boot.

This year, legislators have introduced two bills to deal with the problem, Senate Bill 56, proposed by state Sen. Chuck Hufstetler, R-Rome, and House Bill 84, proposed by state Rep. Richard Smith, R-Columbus. Both have won committee endorsements but have yet to receive a chamber vote.

That means they’re confronting a deadline. Thursday will be Crossover Day, when a bill typically needs to pass at least one chamber in the General Assembly in order to have a chance at becoming law this year.

Both require that companies post prices and network information so patients can look for that information.

Hufstetler’s bill goes further. It would require insurance companies to pay their client’s doctor bills even though they don’t have a contract with that doctor. As in past years, all the controversy revolves around what price the law would set for the insurer to pay. If the price list mandated by the government is too high, it would raise the question why any doctor would sign an insurance contract to begin with, when he or she could instead take the price set by law for out-of-network doctors.

SB 56 pegs the price to a nonprofit price database of medical bills that have actually been paid previously. Insurance companies say those prices are indeed too high, and they oppose the bill.

Over in the House, Smith’s bill wouldn’t require insurance companies to pay the balance at all. It would leave the burden on the patient to ask whether his or her doctors and health care providers would all be in his insurance policy network. It would require health care providers to let the patient know how much they’ll bill the patient, but only if the patient figures out first if he or she needs to ask.

Most of the services involved in those kinds of surprise bills are non-emergencies, where a patient may not know to investigate but at least has time. The Legislature does not appear to be acting on surprise emergency room bills that result where an insurance company may say the patient shouldn't have gone to the emergency room in the first place. A federal suit is pending over that practice.

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