Even if patients go to a health care facility that is in-network with their insurance provider, they can still unexpectedly get a high bill, sometimes months later. Several Georgia legislators hope to change that.
The practice has become known as “balance billing” or “surprise billing,” when patients get a bill from a provider who is out-of-network with their insurance company — such as one who performed part of a procedure at a hospital. For example, at the Northeast Georgia Health System, emergency department doctors, anesthesiologists, radiologists and pathologists negotiate their own contracts with the health system, so a patient’s insurance plan might unexpectedly be out-of-network.
House Bill 888, introduced by state Rep. Lee Hawkins, R-Gainesville, keeps the issue between insurers and providers. If a patient goes to an in-network facility, they would be charged the in-network amount, regardless of whether their provider is in-network or out-of-network. It would be up to the insurer and provider to work out the difference, and the bill outlines an arbitration process through the Georgia Insurance Commissioner’s office.
For nonemergency services, like a routine checkup, patients would be given 48 hours notice before treatment if they have scheduled with an out-of-network provider. Patients could then decide to change their plans or pay the extra amount.
Hawkins’ bill has a Senate counterpart, sponsored by state Sen. Chuck Hufstetler, R-Rome. Both Hawkins and Hufstetler are in the unique position of being both legislators and health care providers, Hawkins as a dentist and Hufstetler as an anesthetist.
Hawkins said the goal of the legislation is taking the burden off patients.
“You go in and you’re getting treated, and you come out, and you still don’t feel particularly good. Typically, you don’t dance out of the hospital,” he said. “…The last thing you want to do, and probably can do, is start negotiating with somebody on the cost of the care you just received.”
Hawkins said over time, the legislation could increase transparency with physicians’ charges and insurers’ payments.
“It’s hard making house payments and raising children, and it’s hard paying medical bills,” Hawkins said. “This is something that will help them know up-front what the bill is going to be, and in the long run, really help reduce some of the cost in health care because the physicians and providers and insurance companies are going to be on level ground to figure out how to approach this.”
Insurers contacted by The Times referred questions to the Georgia Association of Health Plans, which said in a statement that its “members are working with the House, Senate and governor’s office as well as the other stakeholders involved to find a compromise that takes patients out of the middle and keeps health care costs low.”
The Northeast Georgia Health System is watching the issue in the legislature and has been working with Hawkins.
“We absolutely support patients having as much relevant information as possible when making decisions about their health care, as well as the premise of legislation that would help patients make decisions about elective procedures,” Deb Bailey, executive director of governmental affairs for NGHS, said in a statement. “Balance billing is a very complicated issue, as evidenced by the number of bills currently under review — and by the variety of methods these bills propose to implement. We are working daily with all of our legislative delegation, including Rep. Lee Hawkins, who is the lead sponsor of House Bill 888. He has been very supportive of our system and our patients in working to craft the most comprehensive legislation addressing the issue.”
Stacey Cummings, NGHS’ director of system patient receivables, said the system makes an effort to educate patients on the billing process so they can avoid the surprise bill.
“We tell patients during registration, have information included in our General Consent, and post signs in our Emergency Department and Outpatient Registration locations that they may receive additional bills from other doctors or medical specialists who assisted in their care,” she said in a statement. “Most recently, we redesigned our statements to provide a single bill for services provided at any Northeast Georgia Medical Center, Northeast Georgia Physicians Group or The Heart Center location.”
Other legislators have proposed different solutions that would provide patients with more information before treatment, alerting them to the possibility that a provider at an in-network facility could be out-of-network. House Bill 789 would create a “surprise bill rating system” based on how hospitals contract with providers. Senate Bill 303 would require insurers to set up a website and phone number where patients could receive price estimates and learn about quality of care.