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Legislation aims to tackle "surprise billing"

Posted at 2:51 PM, Feb 24, 2020
and last updated 2020-02-25 09:03:45-05

House bill 387 revolves around "surprise billing" — though physicians think a more appropriate name is "surprise lack of coverage." One thing, however, is a commonality; both insurance companies and physicians want patients out of the middle.

"The patients are going to in-network providers and expecting that in-network cost," said representative Megan Blanksma.

Patients aren't always paying those in-network costs, though, because not all necessary providers a patient might see are contracted with their insurance companies, which can lead to those jaw-dropping medical bills.

"I know that I've dealt with it twice, once when I had an accident once when my son had an accident, both times we had surprise billing issues, to me it's just not right that patients are forced into contracts with these providers," said Blanksma.

As in place now, insurance companies are supposed to make patients aware of what the maximum out of pocket cost will be. The issue is some patients end up with another statement directly from providers with additional charges for their services.

"if you go to a facility that is in your insurance network, you shouldn't receive a surprise bill for an amount above and beyond what your insurance coverage is already paying that facility," said vice president of public affairs for Blue Cross of Idaho Mike Reynoldson.

However, ER doctors say they're not the bad guys.

Under the Emergency Medical Treatment and Labor Act, they can't legally ask their patients for insurance coverage until their condition has been stabilized and treated. After that point, they can ask and refer to the patient.

"Someone gets in an ambulance, they might be unconscious, that ambulance is going to take them to the closest emergency department that can provide life-saving care," said ER physician Jonathan Miller,

"nobody is digging through a patient's wallet or purse to figure out what insurance company they have."

Doctors agree, however, that they don't want patients paying for something that should be settled between insurance companies and physicians.

"The issue is we are on the same page as physicians because we are patients too, and I have family members too," said Miller.

Twenty-nine other states have similar bills to HB 389, though all somewhat different. Miller hopes to see language added for independent dispute resolution, which would keep the patient out of it while compensating doctors fairly for their services.

"I make life or death decisions to give that patient the best care and expect to be reimbursed fairly by that insurance company, and more importantly, that patient expects that," said Miller.

House bill 387 is awaiting a hearing in the Health and Welfare Committee..