ATLANTA — Legislation that would protect some patients in Georgia from surprise medical bills that can run to tens of thousands of dollars is gaining momentum at the state Capitol.
A Georgia Senate committee approved a bill Wednesday, Feb. 19, that would require insurers in many cases to pay for care by a doctor or at a hospital that is not within their network of medical providers and limit patient liability for those charges.
Georgia lawmakers have been working on legislation to regulate surprise billing for years.
A mirror bill is also advancing in the state House, introduced by Gainesville’s Rep. Lee Hawkins, and Gov. Brian Kemp identified the issue as a top priority for the year during his annual state of the state address.
Hawkins’ bill 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.
The Northeast Georgia Health System is watching the issue in the legislature and has been working with Hawkins.
“If we don’t pass a balanced bill or surprise bill this session, I think this is a failed session,” state Sen. Ben Watson, a Savannah Republican and doctor who chairs the Senate Health and Human Services Committee said Wednesday after the committee approved the surprise billing legislation.
Surprise bills can come about when patients in an emergency end up at a hospital that’s not in their insurer’s network. Or a patient may have surgery at a hospital in network, but an anesthesiologist or other doctor that helped with the procedure is not in network.
The Georgia Senate bill would protect patients in both cases from any financial responsibility beyond what they would normally have to pay in coinsurance, a copay or deductible.
“This system sets up a method that holds the consumer harmless,” Sen. Chuck Hufstetler, an anesthetist and a Republican from Rome, who co-sponsored the bill, said at the health and human services committee meeting.
Usually, patients pay a bigger share of the bill for any care sought outside networks that insurers form with doctors and hospitals, in part, to gain some leverage for negotiating reimbursements. They may also be on the hook for additional costs because out-of-network doctors or hospitals can charge them more than what their insurance companies pay.
A study released last year by the nonpartisan Kaiser Family Foundation found surprise bills follow treatment roughly 1 of every 6 times someone is taken to an emergency room or checks into the hospital.
About half the states in the U.S. have approved laws that regulate surprise billing, but like the proposal in Georgia, their reach is limited because states don’t have jurisdiction over most health plans sponsored by large employers. Those plans cover about 100 million people and operate under the umbrella of a federal law.
In Washington, lawmakers have been working on legislation that would apply across all types of insurance plans, from individually purchased coverage to workplace insurance sponsored by national companies.
President Donald Trump and House Speaker Nancy Pelosi have said they want to pass a bill this year, but the legislation is hung up in a dispute over how the out-of-network hospitals and doctors should be paid by insurance companies.