The Atlanta Journal-Constitution
Surprise bills
It also doesn’t apply to voluntary “coverage” cooperatives known as health care sharing ministries, such as Medishare, which are not real insurance and are not regulated by the state.
A spokesman for the governor, Cody Hall, did not say outright that Kemp would sign the bill, but he noted surprise billing is an issue the governor fought to rein in.
“Families are living on a prayer because the system is rigged against them,” Kemp said in his State of the State address this year, promising to “craft a legislative remedy to reduce surprise medical billing.” As written, HB 888 would do just that, if the Department of Insurance is able to create the system the bill envisions for regulating prices and disputes.
Hall said the governor’s office now has the bill under legal review, which is standard practice before legislation is signed.
A long-standing problem
Surprise bills happen when a patient with proper insurance gets treatment from a facility or a health care worker who turns out to be not in their insurance company’s network.
Each insurance company has a network of facilities and providers that they’ve negotiated contracts with for agreed prices. Clinics, doctors and hospitals that haven’t signed contracts with that company are out of network. Some out-of-network medical bills are unreasonably high, critics say.
Even if a patient is treated at an in-network hospital, that isn’t a guarantee that all the health care providers are, as well. For instance, the emergency room doctor, or anesthesiologist, or radiologist who evaluates the scans may be an independent contractor.
For Jason Doss, an attorney whose clients are suing the insurance giant Anthem, the bill would be “a step in the right direction,” he said, but one with big holes that would leave patients vulnerable. While the bill defines what an emergency is, he noted, it doesn’t say who makes the final
Second medical fees bill moves forward
The Georgia Senate approved another piece of legislation Monday that aims to cut down on instances where patients are hit with hefty medical bills.
It now goes back to the House for approval.
House Bill 789 would help patients check to see which doctors in the four most common specialties — anesthesiology, emergency medicine, pathology and radiology — would be covered by their insurance.
The legislation would require insurance companies to keep an online directory of these specialists and mark whether each doctor accepts their insurance plan.
If signed into law, the bill would go into effect in October, allowing the ratings to be posted before open enrollment begins for health insurance. The effective date would give insurance companies time to let their customers know about the changes and allow them to update their websites.
Lawmakers have spent several years trying to tamp down on “surprise medical billing,” including the passage of House Bill 888. It would require patients to pay no more than their deductible, co-pay or other in-network payment level determined by their plan. call if there’s a dispute about that with the patient. Anthem has a history of denying emergency claims from its policyholders, saying the patient’s condition wasn’t really an emergency.
“People go to the hospital all the time because it’s an emergency to them,” for instance, chest pains, Doss said. “So, if it later gets determined by an insurance company it’s not, then the risk is on the patient.”
And, there’s the issue of knowing who is and isn’t in network. Under the new legislation, a patient who’s referred to an outof-network doctor would have to be informed orally and in writing of that fact and given an estimate of the cost. But when it comes to hospitals, the bill assumes the patient knows on their own.
Insurance companies’ lists of in-network providers aren’t always accurate. And sometimes they change. In 2019, Anthem dropped Wellstar from its individual plan network, and many policyholders only found out when they went to make appointments. All of Cobb County’s hospitals are Wellstar facilities. Doss represents clients with Anthem insurance plans who needed Wellstar hospitals and doctors and found themselves stranded.
HB 888 “assumes that the insurance company is telling the truth about which doctors and hospitals are in network and which ones are not,” Doss said. “That’s one big issue.”
Still, the new law could prove very useful for patients who receive emergency treatment. Any patient with an individual insurance plan could not be billed by the hospital or doctor for more than the regular co-pay or outof-pocket fee.
Instead, the legislation would make the insurance company pay the doctor or hospital what they would normally pay for in-network services. The bill would have the state Department of Insurance maintain a price list of prices paid locally for particular services, and it would also have the department write rules to set up an arbitration system if the insurance companies and health care providers couldn’t work it out on their own. In such cases, the key element is that the patient would be out of the fight.
A representative for health insurance companies, Jesse Weathington, said that he expected the DOI to have the system up and running January 1, 2021.
“It took a lot of leadership to break the deadlock and get this bill passed,” he said. “It’s a win for consumers.”