At A Glance: Georgia state representative Richard Smith, a republican from Columbus has introduced a bill that could put an end to unexpected medical bills patients receive after hospital procedures.
The Problem: Imagine you recently had surgery. You have decent insurance, and you’re aware there will be some cost to you for the procedure, but you met your deductible three months ago, so you have an idea of what the costs are and have planned accordingly. The bill comes and you owe about what you expected. A week later, while you’re still recovering, you get another bill from a doctor you’ve never heard of for $3,000. Now, instead of focusing on your recovery, you are panicking over a bill you didn’t expect that you’re not sure how you will pay.
How It Happens: Unexpected medical bills like this happen when an out-of-network doctor is involved in a patient’s care even though the hospital is in-network. The patient’s insurance company doesn’t have a relationship with that doctor and will not pay for the doctor’s services, despite the fact that they approved the procedure. This is commonly seen with anesthesiologists, but it can happen with any specialist.
The Bill: Smith’s Bill, House Bill 678, would require hospitals, at the request of the patient, to give notification prior to surgery of every doctor they will be seeing, how much they will be charged and how much insurance will cover. The bill also requires out-of-network charges to be billed within 90 days after the procedure and for any disputes to be settled within 90 days. The House Insurance Committee recommended passage of the bill Thursday.
Why It Matters: About 22 percent of Georgians have medical debt that has been turned over to collections agencies.
Loopholes: According to Georgia Watch, while the bill is a step in the right direction, it does not protect patients in emergency situations and patients who dispute out-of-network charges still have to handle the dispute themselves instead of having the hospital, the out-of-network provider and the insurance company work it out while the patient recovers. Also, it appears patients have to request the notification prior to the procedure.
History: Smith filed a similar bill last year, but that bill would have required all doctor’s working at a hospital or medical facilities to be certified under that facility’s insurance network plans. That bill also passed in the committee, but didn’t make it to the house floor by crossover day.
Does It Have A Chance?: The insurance industry is a powerful lobby and that often slows down meaningful health care changes. However, since this year’s version of the bill doesn’t require every doctor to be certified on a facility’s network plan, it may have a better chance.