“Surprise medical billing” has been a hot topic in the General Assembly this session, and I am hearing about this issue from many folks in the district.
You may have experienced this scary problem yourself. A few weeks or months after a medical procedure, you get a bill from an unknown medical services provider that says you owe additional money, on top of what your health insurance has already paid. In many cases, these surprise bills are in the thousands of dollars. These notices usually say that one of the health care providers was “out-of-network” and because of this, you owe “full price.”
There are two bills circulating the General Assembly that are attempting to deal with this issue. In the State House there is HB 71, and in the State Senate there is SB 8. The House bill and the Senate bill have similar goals and language related to pre-service medical cost disclosure, but the bills also have significant differences.
House medical billing plan
HB 71 requires that medical providers make clear disclosure of the health insurance plans they accept. In addition, prior to medical procedures, the medical provider must provide the projected cost of the procedure to the patient. So far so good, but here comes the part doctors do not like. The bill requires all doctors working at a hospital, surgical center, etc. to be “in-network” for all insurance the facility accepts. Physicians contend this requirement weakens their ability to negotiate fees and forces them into an insurance contract on a “take it or leave it” basis.
Senate medical billing plan
SB 8 attempts to address the out-of-network/surprise fees differently.
SB 8 proposes an out-of-network fee schedule that would constrain a surprise bill to a percentage of what is paid for the service in-network, in the specific geographical area where the procedure was performed. In addition, SB 8 proposes a mediation system to resolve disputes in this arena.
One of the concerns about SB 8 is that other states that have implemented a similar mediation system have been immediately overwhelmed by the number of mediation cases.
This is the beginning of what is sure to be a major public policy debate. If you have specific questions about this issue or others, please contact me at [email protected] or 404-656-0325.
About the author: Rep. Dan Gasaway (R-Homer) represents the 28th GA House District. His district includes Stephens and Banks Counties and the southern end of Habersham. Rep. Gasaway is Secretary of the House Human Relations & Aging and Natural Resources & Environment House Committees. He also serves on the House Budget and Fiscal Affairs Oversight, Higher Education, and Insurance Committees.
