An agreement between a health insurer and a Rome hospital has shaved more than $10,000 off a surprise medical bill for a young asthma patient.
Liam Stina’s hospital bill of more than $11,000 was featured in a Georgia Health News article last week.
But the state department of insurance said Wednesday that a verbal agreement was reached between Floyd Medical Center and Anthem, which insured the Stina family. The hospital agreed to accept Anthem’s payment for the care of Liam, and Floyd Medical wrote off much of the remaining bill, bringing the final total to $995.53.
Liam, then 4, was first treated in August at Redmond Regional, which transferred him by ambulance to Floyd Medical Center because of the latter’s better pediatric capabilities. Floyd was not in the Stina family’s HMO network, but Liam’s case was an emergency, so the family did not expect a huge bill.
Yet the final bill to the family came to more than $11,000. That surprise expense prompted Lelia Stina, who works with her husband in the restaurant business, to contact GHN and state insurance officials.
When the family got word this week that Liam’s hospital bill was being reduced substantially, Lelia Stina said the move “was amazing. I am extremely grateful.”
The issue of a balance bill from a non-network hospital for emergency care – as occurred in the Stina case — arose as a big issue this week in legislative hearings on proposals to curb surprise billing.
The legislation, Senate Bill 359 and House Bill 888 focuses on surprise billing that occurs after elective surgery or emergency care when the facility itself is in the patient’s insurance network but the ER physician, anesthesiologist, radiologist or pathologist is not. In such cases, the patient gets a separate, unexpected bill from that out-of-network doctor, and it can reach into the thousands of dollars.
But surprise billing can also come from hospitals, in the form of balance billing, if the facility is out of network. Balance billing means the patient faces paying the balance of high charges remaining after insurance payments.
At a House hearing Tuesday, legislators pointed out that the proposals do not address surprise bills from non-network hospitals for ER care.
Rep. Sharon Cooper, a Marietta Republican who alluded to the Stina case in her remarks, said such balance bills “could quadruple anything you could ever get from a doctor.’’
The hospital billing situation was left out of the proposals because “it’s a mammoth issue by itself,’’ said Rep. Lee Hawkins, a Gainesville Republican who is the lead sponsor of House Bill 888. “That’s an issue for another time.’’
Yet that balance billing problem appeared to be ironed out Wednesday, with both the Senate Health and Human Services Committee and House sponsors agreeing to have the legislation address the ER care from non-network hospitals.
Sen. Chuck Hufstetler of Rome, the lead sponsor of the Senate bill, said a situation like that of the Stinas would now be covered with changes that were made Wednesday in both bills.
With those revisions, the Senate panel unanimously passed the legislation. It now goes to the Senate Rules Committee.
Under the identical proposals in the two chambers, insurers would pay out-of-network physicians the same amount for a service (or a similar service) as a physician in the network would be paid. If there’s a disagreement on the payment rate, the two sides would enter an arbitration process overseen by the state Department of Insurance.
The legislation would not pertain to people covered under self-insured health plans run by large companies, says Hufstetler.
But it would cover more than 2 million Georgians who have coverage that’s regulated by the state, as well as individuals in the health insurance exchange and people covered under the state employee and teachers’ health plan.
Consumer groups have supported the legislation. Laura Colbert of Georgians for a Healthy Future said Tuesday that the legislation “is a big step forward for Georgia consumers.’’
Liz Coyle of Georgia Watch noted that the struggle to resolve the surprise billing problem has persisted for years under the Gold Dome because lawmakers repeatedly deadlocked on what kind of legislation was needed.
“We are very hopeful this is the year it gets done,’’ Coyle told the House Special Committee on Access to Quality Health Care.
At the House hearing Tuesday, Anna Adams of the Georgia Hospital Association said that “the hospital always wants to be in-network’’ but that “sometimes a contract can’t be reached.’’
She said some insurer networks are narrow and are not adequate for consumer coverage.
Despite lawmakers’ dissent on the hospital issue, House Bill 888 squeaked out of committee, but only because the chairman, Rep. Mark Newton (R-Augusta) broke a tie.
But the Wednesday revisions appear to resolve the remaining conflicts over wording.
Finally a happy surprise
The Stina example was cited at the hearing as illustrating a gap in the bill that should be addressed.
The state insurance department last week worked to help resolve the situation.
Lelia Stina expressed relief and joy at this outcome. “I feel like [a person who’s] winning the lottery,’’ she said Wednesday. She told GHN that she heard from many people on Facebook about similar high medical bills.
“I hope my voice is the voice of many people who have even bigger bills,’’ she said.