ATLANTA — The effort to reduce “surprise’’ medical bills in Georgia took another key step last week with legislation passing a Senate health committee.
Senate Bill 359 is similar to but broader than a proposal that has already passed the House. The Senate version has provisions on payment for non-network medical services that the insurance industry opposes.
Sen. Chuck Hufstetler, a Rome Republican who’s the lead sponsor of 359, said the legislation aims to take the consumer out of the middle of the battle over payments for emergency care between insurers, doctors and hospitals.
The General Assembly has considered several proposals on surprise billing over the past three years, but legislative approval has proved elusive.
Surprise medical bills can involve hundreds and even thousands of dollars in out-of-pocket patient costs.
This billing occurs when people have procedures or visit ERs at hospitals in their insurance network, then are hit with separate, unexpected charges from non-network doctors who were involved in their care. These bills can come from ER doctors, anesthesiologists and radiologists, among others. Several states recently have passed legislation to address the problem.
Hustetler’s bill would set up a system that would prohibit surprise billing in emergency care situations. It would calculate payment to non-network medical providers on a percentage provided by a benchmarking database.
That’s the provision that most concerns the insurance industry. Those rates would exceed usual contract amounts and would lead to a rise in insurance premiums, Graham Thompson, executive director of the Georgia Association of Health Plans, told the Senate Health and Human Services Committee, which unanimously passed Senate Bill 359.
Other provisions would increase the transparency to consumers about non-network providers and rates for elective procedures, and would establish a mediation apparatus for surprise bills.
“I’m very hopeful the House and Senate can come together’’ to pass legislation on surprise bills, Hufstetler told GHN after the panel vote. “It will require doctors, hospitals and insurance companies to all come together.’’
The House bill, sponsored by Rep. Richard Smith, a Columbus Republican, seeks to ensure the patient gets help making decisions through increased transparency of medical costs. Health care pricing “is like a black hole’’ for patients, he told GHN recently.
Under House Bill 678, a consumer getting non-emergency services from a hospital, physician practice or treatment facility would, upon request, receive information on whether the medical providers involved are in the patient’s insurance network, what the fees will be, and how much the patient’s policy will pay, Smith told GHN.
The proposal would also require insurers to give information to members on obtaining a referral to a health care provider outside their network when the health plan does not have a provider in their geographic area. It also would make the insurer disclose the amount that would be reimbursed under out-of-network services.
The House proposal is supported by the Georgia Association of Health Plans.
Hufstetler said Smith’s bill does give consumers price transparency on out-of-network medical bills, but “doesn’t solve the problem’’ of surprise bills.
He said Georgia had been found to have a high number of “narrow’’ insurance networks in the health insurance exchange. Narrow networks limit the number of doctors and hospitals available to their enrollees in return for lower prices.
Beth Stephens of Georgia Watch, a consumer advocacy group, praised the Senate bill for banning such billing problems in emergency situations.
“It’s really important for protecting consumers,’’ she said.
Stephens told GHN that she hopes insurers and medical providers can agree on a payment metric for out-of-network services “so we can move forward to protect consumers.”
Andy Miller is editor and CEO of Georgia Health News.