Local legislator tackling 'surprise billing' issue

Jan. 22--State lawmakers are hoping to ease the health care burden during the legislative session to begin in February, as three representatives have announced their intention to end "surprise billing."

It's not uncommon for Oklahomans to receive medical bills they weren't planning on, since the state is one of 25 without laws in place to protect against surprise billing. This can occur when patients are treated by providers outside their insurance networks, without their knowledge. Also known as "balanced billing," the practice can leave Okies with financial hardship because an out-of-network health provider will issue bills in a greater amount than a patient's cost-sharing obligation that would apply for the same services by an in-network provider.

Legislators, health care providers, health insurers, and the Oklahoma Insurance Department reportedly tried addressing the issue during the last session, but the parties could not reach an agreement.

"However, we are extremely pleased with the pace of negotiations over the interim," said State Rep. Marcus McEntire, R-Duncan. "We are happy to announce an agreement with health providers and insurance companies to hold enrollees harmless to surprise bills and prohibit the practice of surprise billing. Both the insurance companies and health providers emphatically stated in our meeting the patients should be held harmless."

The issue has also been scrutinized by lawmakers in Washington, D.C., as House and Senate members have reportedly agreed on a measure to prevent patients from receiving large, unexpected bills. While conservative groups are planning to the oppose the legislation, it is thought to be one of the few health care bills that could reach President Donald Trump's desk this year.

It appears as if state legislators from both sides of the aisle are willing to work toward a better system. State Rep. Chris Sneed, R-Muskogee, said House Bill 3388, which would create the Out-of-Network Balance Billing and Transparency Act, should receive bipartisan support from lawmakers, and that health care officials are on board with addressing surprise billing.

"Right from the get-go, it doesn't matter which party was talking about the situation of surprise medical bills; they've all said, 'Let's get the patient or the insured out of the middle,'" said Sneed. "They don't need to be involved in dealing with this or having more stress added to them in these situations."

Sneed and State Rep. Tammy Townley, R-Ardmore, have been working on the issue since last spring and have held several general studies and roundtable discussions. Sneed, who has a background in insurance, said he's had clients over the years receive surprise medical bills and he knows the kind of toll it can take on patients.

"Typically, you've been to the doctor or had a surgery or something like that, and 60 to 90 days later, all of a sudden you get this bill and you're thinking, 'Oh, gosh, where did this come from?' And it's usually a large bill," said Sneed. "That's really why I wanted to dive into it."

Between now and the session, legislators and health care officials will try to fine-tune measures to prevent Oklahomans from having to pay exorbitant medical bills. Sneed said it could come in the form of having independent arbitrators set benchmarks on how much insurances will have to fork over to providers.

"Arbitration would really be the last and final step of the process if they couldn't get it worked out," he said. "Really, what we're looking at is there's a company out there -- a third-party administrator -- by the name of Fair Health, and there are some others out there that we're looking at to see with their database of what would be a usual and customary price."

Legislators hope to see the bill pass early in the session, so it can make to Gov. Kevin Stitt's desk and go into effect in November. Sneed said he's also looking at ways health care patients can find out good-faith estimates for planned procedures and whether anyone involved in a surgery or operation is out of the patient's insurance network.

"We're trying to make it to where you, the insured person, can find those things out," Sneed said. "Obviously, in an emergency situation, you wouldn't be able to find out or make phone calls and ask if everybody is going to be in the network."

Requests for comments to Northeastern Health System and Northeastern Oklahoma Community Health Centers were not returned by press time.

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