EDITORIAL: Take surprises out of medical bills

Augusta Chronicle (GA)

Feb. 13--Talk about a medical emergency.

The problem of "surprise billing" for health procedures is one of those political issues that find strong bipartisan support, yet resist an easy solution.

This unnerving circumstance might have befallen you or someone you know: After receiving medical care covered by your insurance network, you are hit later with more charges from caregivers outside your network. Maybe you needed spur-of-the-moment treatment, or perhaps some of your in-network care was administered by an out-of-network physician.

Of course, you didn't know about those other charges. When lying on a stretcher, who has the presence of mind to ask busy doctors and nurses whether they're within the right insurance plan?

When out-of-network doctors and insurance companies can't agree on a price for services rendered, the unsettled amount gets thrown back on the patient to pay. Whatever medical ailment had been cured gets replaced by outrage and stressful worry.

However surprise billing happens, it shouldn't.

And everyone agrees -- health professionals, insurance firms, lawmakers. Still, nothing meaningful gets done to rectify the problem.

To combat surprise billing, two possible solutions have surfaced -- arbitration or benchmarking. In arbitration, the out-of-network care provider and the insurer each set their own desired price, and a third-party arbiter makes the final price decision. In benchmarking, a government agency sets the compensation rate for seeing out-of-network patients.

Deciding between those options has been a big knot in the hose. Insurers and medical specialists can't seem to agree on exactly how out-of-network costs should be settled.

Last May, the Trump administration publicly made surprise billing a priority, and Congress is wrestling with the problem now. Maybe that renewed federal urgency has sparked states to move on the issue, too.

In Georgia, one possible answer comes from Republican Rep. Mark Newton of Augusta, the House's chief deputy whip and himself a physician. He's the primary sponsor of House Bill 789, the Surprise Bill Transparency Act, that would let Georgians use a rating system to learn which physician specialists are covered in certain insurance plans at particular hospitals.

If passed, insurers would be required to disclose their "surprise bill ratings." A low rating would also require insurers to reveal which of four specialist types -- anesthesiologists, pathologists, radiologists and emergency room doctors -- are out-of-network.

Newton's bill passed a House committee Monday, and we hope it advances. Any bill that takes a stand in favor of public transparency is a bill worth passing.

Companion House and Senate bills pushing forward this year provide a larger-scope compromise to surprise billing.

Disputed procedure costs still would go to arbitration, overseen by the state's Department of Insurance. Decisions and payments then are recorded into the department's database. Those figures would be used to help calculate baseline "contracted amounts" for out-of-network procedures. Those are the costs insurers would have to reimburse.

Several tweaks and modifications appear to be in store for those companion bills. Questions are lingering about exactly how those contracted amounts would be set.

But at least the surprise-billing issue is being pushed as a top priority in this year's General Assembly. Georgia patients are sick of getting soaked by unforeseen medical costs that spring frighteningly out of nowhere like some gruesome jack-in-the-box.

Let this be the year that lawmakers, health professionals and insurance companies all can finally agree on a policy that reins in surprise billing.

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