Surprise bill fix on a path to pass
Sen. Chuck Hufstetler is slated to present the measure to a Senate committee Sunday.
Georgians have a good shot at getting relief from surprise medical bills this year, despite a heavy focus on the budget when state lawmakers reconvene Monday for the last 11 days of the session.
House Bill 888, by Rep. Lee Hawkins, R-Gainesville, is scheduled for a hearing Sunday in the Senate Health and Human Services Committee. It’s being presented by Sen. Chuck Hufstetler, R-Rome, whose Senate Bill 359 is essentially the same.
Hufstetler said Friday that they’re putting all their efforts into Hawkins’ bill, which lacks only the hearing and a Senate floor vote.
“That’s the quickest path to get it passed ... We’ve done identical bills all the way,” he said.
The measure addresses the problem of patients getting socked with hefty “balance bills” when they thought all of the providers involved in their operation were in-network. It essentially removes them from a dispute between what a provider wants to charge and what their insurance company is willing to pay.
“I expect it get it done and get it passed out to the governor this week,” Hufstetler said.
Instead of consumers getting a balancedue notice — sometimes months after an urgent or emergency procedure — any payment dispute would be resolved through arbitration.
The bill takes into consideration longstanding concerns that have led both insurers and medical providers to block other proposals through the years.
Hufstetler said insurers would have to promptly pay providers an amount set by a formula based on their negotiated rates. The case could end there but if either side is dissatisfied, they could take it to the Georgia Department of Insurance.
The arbitration process is set up “baseball style,” he said — with each party presenting what they want and the arbitrator choosing one or the other amount. Hufstetler said it works better than a compromise, since they are both motivated to convince the arbitrator.
It also sets a time limit for resolution.
For elective medical procedures, the legislation requires patients to be notified at least 48 hours in advance if a scheduled provider is out of their network. The patient could then decide to pay the difference or reschedule the procedure.
“Almost half of Americans have experience with surprise bills ... Medical bills are the No. 1 reason for bankruptcy in Georgia and one in six (emergency room) inpatient stays result in a surprise bill,” Hufstetler said when presenting his bill in the Senate.
The measure has a broad coalition of support, assembled painstakingly since last year — when another try by Hufstetler failed to make it out of a House committee chaired by Rep. Richard Smith, R-Columbus.
Hufstetler and Smith worked together on drafting the new legislation — taking input from doctors, hospitals, insurers, lobbyists and patient advocates. Help from Georgetown University’s Center on Health Insurance Reforms got them to solutions that have been successful in other states.
Smith was appointed to chair the House Rules Committee in January and Hawkins took up the banner in his place. Hufstetler said he and Hawkins have been careful to keep the language in their bills the same as they moved through the process.
The Senate passed Hufstetler’s bill unanimously, without debate, in February. Hawkins’ bill passed the House, 164 to 4, in March. The later measure contains some minor adjustments that Hufstetler said were aimed at strengthening support.
With the second half of the legislative session “on a tight schedule,” Hufstetler said, he did not want to press for his bill, which would have had to be amended and sent back to the Senate for another vote.