A bill to fix the problem of "surprise billing" of patients after hospital stays may yet offer relief for patients, since it has survived an important deadline in the Legislature.
Surprise billing is also known as “balance billing.” It’s when an insured patient gets a procedure in a hospital in his or her network, with a doctor in his or her network. But to their surprise, they get a bill later from yet another doctor who was involved — maybe the radiologist, or the pathologist — who happened to be on contract with the hospital and not in its network. Basically, without a contract the doctor bills as much as they want, the insurance company pays as little as they want, and the patient is left to pick up the rest. It’s an unexpected bill, but it’s legal.
For now.
There are two measures that would deal with the issue, one that came from the House and one from the Senate. The one from the House, House Bill 71, was tabled early in the day on Friday by a 160-12 vote of that chamber, meaning it’s likely dead for the year. Friday is “crossover day,” when any bill at the Georgia Legislature must pass at least one chamber to surve that year.
But the other bill, Senate Bill 8, had already passed the Senate; and backers expect activity in the House Insurance Committee. Tabling HB 71 means the House can now concentrate on SB 8.
It’s got momentum and a sponsor with ranking and passion for the issue, Renee Unterman, R-Buford, chairwoman of the Senate health committee. But it’s also got interest groups — insurance companies and doctors — who are still fighting each other over it, and stand to lose a lot if the provisions of the bill aren’t written their way. So there’s no guarantee it will pass.
At the moment, SB 8 would cap the amount the doctors can bill for their services, probably using a database of payment levels advocated by the group FAIR Health and cutting that amount by 20 percent. Insurers say the rates in that database are skewed toward the doctors, but doctors say the fee levels are fair and should not be cut at all.
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