HB 888 wouldn’t stop all types of unexpected large medical bills. But it would land a solid blow against cases when a patient goes to a hospital that is in his or her network and is treated by someone within that hospital who is out of network.
The bill’s sponsor, state Rep. Lee Hawkins, R-Gainesville, said he did what he could. “That’s a mountain that’s really hard to climb,” he said.
The bill passed on a vote of 4-4, with Committee Chairman Mark Newton, R-Augusta, breaking the tie. Newton and Hawkins called the bill an important step forward.
The big problem with solving surprise billing is getting health care providers such as hospitals and doctors to agree with insurance companies on the right price to pay for a service when the patient has insurance but the provider is out of the plan’s network. In cases where HB 888 would apply, the state would set up a database with benchmark prices, and if the two sides still didn’t agree, they could go to binding arbitration. The patient would only be responsible for the co-pay as usual and not be involved in the arbitration fight.
It would not apply to employer-based health plans.
State Rep. Todd Jones, a Republican from south Forsyth County, said he voted for the bill despite his reservations.
“We’re nibbling around the edges as opposed to actually cutting it up and saying, ‘We have to digest the idea of how do we handle a surprise emergency facility visit,’ ” Jones said. “At the end of the day you don’t have a choice when it’s an emergency situation.
“Given the choice between getting a little bit done and getting nothing done, I’m going to choose to get a little bit done,” he continued. “But I hope that the Legislature, the governor’s office and the lieutenant governor’s office realize that this is just one small step. And we have a lot in front of us that we need to address in terms of access and coverage.”
The types of unexpected medical bills HB 888 doesn’t tackle include bills at out-of-network hospitals, even for emergencies. For example, the insurance giant Anthem dropped the WellStar Health System from its individual network, leaving all of Cobb County without a single in-network hospital. Anthem was out of network with the Gainesville-based Northeast Georgia Health System for months until renewing a contract in January.
The Senate has similar legislation, Senate Bill 359. It has yet to be voted on but is scheduled for its second committee hearing Wednesday.
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