7 states addressing surprise medical billing so far in 2017
Legislators from seven states have proposed legislation in the first few months of 2017 to mitigate the practice of surprise medical billing.
Surprise billing, or balance billing, refers to instances where patients receive an unanticipated and costly bill from a medical provider. This most often occurs when patients are treated by out-of-network physicians who don't have pre-determined payment contracts with the respective payer. Out-of-network physicians may bill patients for any outstanding balance on their hospital bill once the patient's insurer submits its payment — which is typically less than the equivalent Medicare rate.
According to data compiled by the National Academy for State Health Policy, 19 states proposed legislation addressing the issue of surprise billing in 2016. Of those, seven states successfully passed legislation addressing various facets of the issue.
Here are seven states in which state legislators have proposed legislation addressing surprise billing so far in 2017.
1. Rhode Island — House Bill 5012
The legislation would allow the state's health insurance commissioner to establish a process for patients to challenge disputed medical bills.
2. Georgia — House Bill 71, Senate Bill 8
The bills would mandate caregivers improve transparency with patients regarding which physicians will be participating in the patients' care journey. Both bills do not require the hospital to explicitly state which physicians would be considered in-network for each patient. Neither bill would eliminate patients' out-of-pocket expenses, such as deductibles and co-pays.
3. Ohio — Senate Bill 284
The proposed legislation would prohibit emergency physicians from billing out-of-network payers at a higher rate than the payer's in-network reimbursement rate for emergency care. The bill also aims to create patient scheduling services to provide patients with more information about potential out-of-pocket costs.
4. Oregon — House Bill 2339
The bill would regulate the rate insurance companies pay out-of-network providers for services to ensure "fair and reasonable" payment.
5. Arizona — Senate Bill 1441
The bill would allow the Arizona Department of Insurance to intervene in some balance billing cases. Specifically, the bill would apply to instances when patients were unable to determine whether the medical provider was in-network, and feel they were unfairly charged. Under the bill, patients would also only be responsible for paying the normal co-pay amount and deductible, in most situations.
6. Utah — House Bill 395
The legislation aims to regulate the rate out-of-network emergency physicians can charge payers for emergency. The law would institute a national benchmark for usual emergency care to determine the maximum price.
7. Texas — Senate Bill 507
Under the proposed legislation, the state would be allowed to mediate balance bills for care administered by an out-of-network physician at in-network freestanding emergency departments and in-network hospitals and for all providers. The bill also calls for an expansion of the state's disclosure requirement and would require providers to include a disclosure stating "this is a balance bill that may be eligible for mediation."
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