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Hawkins aims to tweak surprise billing law for self-funded health care plans
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Rep. Lee Hawkins, R-Gainesville. - photo by Nick Bowman

Rep. Lee Hawkins, R-Gainesville, hopes to build on the successes and tweak unintended consequences that his recent legislative efforts have made in helping patients in Georgia avoid surprise high-cost medical expenses in times of emergency.

Hawkins introduced the Surprise Billing Consumer Protection Act, formerly titled House Bill 888, in February 2020 which states that health insurers can't send balance bills, commonly referred to as "surprise" medical bills, to patients who received emergency service from an out-of-network health care provider.

 “How I approach legislation is by asking myself ‘how would I want my family and my friends to navigate through these systems’ and what should they have the option to do when it comes to their health,” he said. “We want to continue to make progress when it comes to health insurance and meets any unintended consequences that come up.”

Under the law, patients don’t pay any more than their deductible, copay or in-network requirements in these situations.

Additionally, the law requires the state’s insurance department to run an all-payer health claims database, establish an arbitration process and providers can request arbitration for additional payment from health insurers without patient involvement.

House Bill 234 aims to amend Title 33 under Georgia Code by providing an option for self-funded health care plans exempt from state regulations under federal law to opt-in to Georgia's Surprise Billing Consumer Protection Act.

“To me, insurance should be a choice, and I’m not a fan of government interference in those matters,” Hawkins said to the Times. “We want to give people a choice when it comes to the insurance that can cover them and their family.”

Self-funded insurance plans are often subject to less federal regulation, and employers can select customized their health care plan to the circumstances of their workforce. 

Hawkins said that allowing employers the opportunity to opt-in to the Surprise Billing Consumer Protection Act can be a flexible alternative to insure employees.

“(HB 234) isn’t designed to tell employers what to do or which insurance route to choose,” he said. “It’s all about having the option and the ability to find choices when it comes to getting covered or deciding how to insure your workers.”

Georgia cannot require self-funded health care plans due to the Employee Retirement Income Security Act of 1974 or ERISA, a U.S. labor and tax law that governs workers’ retirement and employer-sponsored health insurance.

Hawkins said that the bill that would allow such health care plans to voluntarily agree to comply with the Surprise Billing Consumer Protection Act’s provisions isn’t in conflict with ERISA.

“When we passed the Surprise Billing Consumer Protection Act, we wanted to make sure that (bill) covered as many people as possible to prevent them from being insured,” he said.

Federal ERISA law does not hold authority over health insurance provided by a church, governmental entity, private-health insurance bought in the non-group markets or publicly-subsidized health insurance plans such as Medicaid.

ERISA is administered and enforced by the Department of Labor, which, according to Hawkins, can be a tough request for federal labor workers unfamiliar with the complexities of health insurance.

The Surprise Billing Consumer Protection Act has only been in effect since Jan.1 and Hawkins said it’s hard to gauge the new law’s success.

“These are one of these issues that might not receive a ton of attention because people may not be following its effects every day,” he said. “Ultimately, we don’t want anyone to be left out of the Consumer Protection Act or be left unable to deal with surprise medical expenses.”

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