ATLANTA - Legislation aimed at ending surprise
bills for emergency hospital visits in Georgia under certain insurance plans
passed unanimously out of the Georgia Senate on Monday.
Senate Bill 359, sponsored by Sen. Chuck Hufstetler, would prohibit hospitals from handing patients unexpectedly large bills for emergency procedures done by specialists who are outside that hospital’s coverage network.
If passed, the measure by Hufstetler, R-Rome, could save patients thousands of dollars in surprise costs for specialty procedures like anesthesiology. It would require medical providers and insurers to work out how to pay for costly out-of-network procedures performed at a patient’s in-network hospital.
It would not, however, include employer-based private insurance plans or costs associated with specialty procedures done in out-of-network hospitals.
Hufstetler said the federal Employee Retirement Income Security Act prohibits state lawmakers from tampering with private-sector health plans.
“We simply have no method of doing so,” Hufstetler said from the Senate floor.
Despite the limitations, supporters have hailed Hufstetler’s bill and an identical measure winding its way through the Georgia House as a means to protect many Georgia patients from crippling surprise hospital charges.
Rather than dropping the full cost for specialty procedures on a patient, the two measures would force insurers and doctors to work out how to pay the extra costs for out-of-network procedures done at in-network hospitals.
Disputes over the final payment would be settled by an arbitration process overseen by the state Department of Insurance. In that scenario, the insurance company would propose one payment amount for a procedure and the doctor would propose another. A contracted arbitrator would pick one of those amounts.
That process would apply for emergency hospital visits and non-emergency procedures that are “medically necessary,” Hufstetler said. Patients could still choose to pay extra for non-elective emergency procedures that are out of a hospital’s coverage network.
The identical measure to Hufstetler’s, House Bill 888, was scheduled for a second committee hearing Monday afternoon. It was sent back to the House Special Committee on Access to Quality Health Care after barely passing out of that committee by a 5-4 vote last week.
The two bills’ progress through the General Assembly comes with high hopes from state lawmakers, doctors, insurers and consumer advocates after years of legislative false starts.
Medical specialists have argued they are underpaid for performing complex technical procedures under in-network insurance arrangements, while insurers claim those specialists charge too much.
Some disagreement remains on both sides over proposed baseline billing rates for specialty procedures and the details of a new all-claims database where arbitration decisions would be logged. The baseline rates and database would influence how the prices of medical procedures would change over time.
Senate Bill 359, sponsored by Sen. Chuck Hufstetler, would prohibit hospitals from handing patients unexpectedly large bills for emergency procedures done by specialists who are outside that hospital’s coverage network.
If passed, the measure by Hufstetler, R-Rome, could save patients thousands of dollars in surprise costs for specialty procedures like anesthesiology. It would require medical providers and insurers to work out how to pay for costly out-of-network procedures performed at a patient’s in-network hospital.
It would not, however, include employer-based private insurance plans or costs associated with specialty procedures done in out-of-network hospitals.
Hufstetler said the federal Employee Retirement Income Security Act prohibits state lawmakers from tampering with private-sector health plans.
“We simply have no method of doing so,” Hufstetler said from the Senate floor.
Despite the limitations, supporters have hailed Hufstetler’s bill and an identical measure winding its way through the Georgia House as a means to protect many Georgia patients from crippling surprise hospital charges.
Rather than dropping the full cost for specialty procedures on a patient, the two measures would force insurers and doctors to work out how to pay the extra costs for out-of-network procedures done at in-network hospitals.
Disputes over the final payment would be settled by an arbitration process overseen by the state Department of Insurance. In that scenario, the insurance company would propose one payment amount for a procedure and the doctor would propose another. A contracted arbitrator would pick one of those amounts.
That process would apply for emergency hospital visits and non-emergency procedures that are “medically necessary,” Hufstetler said. Patients could still choose to pay extra for non-elective emergency procedures that are out of a hospital’s coverage network.
The identical measure to Hufstetler’s, House Bill 888, was scheduled for a second committee hearing Monday afternoon. It was sent back to the House Special Committee on Access to Quality Health Care after barely passing out of that committee by a 5-4 vote last week.
The two bills’ progress through the General Assembly comes with high hopes from state lawmakers, doctors, insurers and consumer advocates after years of legislative false starts.
Medical specialists have argued they are underpaid for performing complex technical procedures under in-network insurance arrangements, while insurers claim those specialists charge too much.
Some disagreement remains on both sides over proposed baseline billing rates for specialty procedures and the details of a new all-claims database where arbitration decisions would be logged. The baseline rates and database would influence how the prices of medical procedures would change over time.
But several representatives for insurance groups and doctors said in committee meetings earlier this month that they largely feel satisfied with the House and Senate bills.
