EDITORIAL: Insurers are billing unfairly for some ER visits. Missouri legislators offered a good, albeit halfway fix.

St. Louis Post-Dispatch (MO)

May 24--Too many Missouri patients get caught in a vicious billing cycle for emergency room visits that wind up not being fully covered by their insurers because of a technicality. The patients get stuck with the balance, which often can be huge. The Legislature made a good-faith effort to fix the problem this session but got only halfway there.

Legislators should go all the way next session and take patients off the hook for balance billing in non-emergency room situations where the patient still has no control over procedures performed by out-of-network providers. Patients need to be protected in all medical situations where they have no choice.

Balance billing is a practice in which patients are billed for the difference of an out-of-network provider that their insurer has only partially paid. Consumer advocates and the hospital lobby want the insurance industry to stop blindsiding patients with huge bills over which they had no control.

Consumer advocates and health policy researchers say the best approach for patients is a comprehensive plan that also would prohibit balance billing in non-emergency settings. A surgical patient, for example, shouldn't be expected to determine if the anesthesiology provider the hospital uses is in- or out-of-network and shouldn't be stuck with a high bill for the service because an insurer refused to pay for it.

The bill awaiting Gov. Eric Greitens' signature sets a floor and ceiling for payments to be established through binding arbitration between insurers and providers, and removes the patient from the middle of the process. Patients would be required to pay what they normally would if the provider was in-network.

The bill is also intended to protect consumers affected by Anthem insurance company's controversial emergency room policy. Anthem refuses to pay for an ER visit that it later determines was unnecessary even in cases where the patient's medical provider ordered it. Insurers have the advantage of being able to examine an emergency room bill after the fact, when they have complete and perfect data unclouded by the stress and emotions of the medical situation at the time.

Patients shouldn't be on the hook for out-of-network charges that sometimes arise from an ER visit, such as when an in-network hospital outsources radiology service to an out-of-network, third-party provider. Patients are expected to pay the difference for the out-of-network provider even if they had no choice deciding who took their X-rays.

If Greitens signs the measure, Missouri will be among at least 21 other states that bar insurers from some balance billing practices. It would protect patients from the time they enter the ER until they are discharged.

Navigating the complexities of health care is difficult enough for patients even without the trauma of an emergency room visit. Missouri legislators should consider expanding the umbrella of protection.

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