Taking ‘surprise’ out of med bills

March 21--Medical patients in Georgia can still get hit with separate and often hefty invoices after they've received what they thought was insurance-covered treatment at their in-network hospitals. But a Senate bill that passed the House Insurance Committee this week is designed to make these notorious "surprise" medical bills less frequent, and less of a surprise.

It has become an unpleasantly familiar phenomenon around the country, and the subject of various kinds of state legislation to address it: A patient who has a scheduled procedure, or worse, a medical emergency, at a hospital in his or her health plan network is later hit with unexpected bills from specialists who were involved in the treatment but, unknown to the patient, are not part of the care network. This "surprise billing" can involve hundreds or thousands of dollars.

Rep. Richard Smith, R-Columbus, had originally sponsored a bill that would have required any doctor certified to work at a particular facility to be a part of that hospital's insurance network. As Smith told Georgia Health News, the reimbursement issue would have involved the doctor, the hospital and the insurance company -- not the patient. But Smith's bill didn't make the Crossover Day deadline.

Senate Bill 8, which Smith's committee approved Monday, doesn't provide the same degree of patient coverage, but it would mandate informed consent: A patient scheduled for surgery or other such medical procedure must be informed if a doctor involved is not in the patient's insurance network. In the case of emergency treatment, the bill creates a formula of reimbursement for out-of network providers. As Smith noted to GHN, patients brought into the hospital with acute injuries or illnesses aren't exactly in a position to poll the ER medical staff on network membership: "It's the one area they have no control over.''

Many physicians, GHN reports, oppose this latest version of the legislation. The Medical Association of Georgia contends the law would result in reimbursement of doctors at "inadequate and unsustainable levels," according to MAG President Dr. Steven M. Walsh, and thus reduce access to care, especially in rural areas. (A previous version of the bill included a reimbursement formula set at 80 percent of "benchmark" rates for a specific procedure -- emergency or non-emergency -- in the area where it is performed.)

Consumer advocacy group Georgia Watch, on the other hand, supports the bill, saying the clause covering patients in emergency situations is the key protection. Problems with medical bills, the organization has said, were the most common subject of calls to Georgia Watch last year.

The reimbursement rate for out-of-network doctors in emergency services can probably be negotiated and fine-tuned. But as Rep. Darlene Taylor, R-Thomasville, told GHN, "Doing nothing helps no one." Given the soaring costs and political/bureaucratic uncertainties -- not to mention the inherent personal anxieties -- associated with health care, providing people with accurate information about what this is all going to cost them should be a baseline imperative.

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