Ohio lawmaker proposes budget amendment to address surprise medical bills

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An Ohio lawmaker has proposed a state budget amendment to tackle large, unexpected bills that often occur after a patient is treated by an out-of-network provider at an in-network facility, according to a Daytona Daily News report.

The amendment proposed by state Rep. Jim Butler, R-Oakwood, requires that an out-of-network provider providing emergency care be paid the in-network rate or the out-of-network rate, whichever is higher, the report states.

Mr. Butler told the Daily News that the bill also includes an arbitration provision to settle price disputes between physicians and insurers.

The arbitration provision is based on a New York law that includes a binding arbitration process inspired by Major League Baseball.

Mr. Butler said that under the Ohio proposal, the provider would be allowed to go to mediation with the insurer if the provider believes the reimbursement was incorrect, and the two sides then could go to binding arbitration if mediation is unsuccessful.

Mr. Butler said his proposal will protect patients and is a fair solution. But the Ohio chapter of the American College of Emergency Physicians opposes Mr. Butler's proposal, saying it does not include definitions for the in-network or out-of-network rates and would put physicians at risk of being shortchanged, according to the report.

The Ohio State Medical Association said the issue should go through the full legislative process and not be added as a budget amendment.


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