State Senate unanimously approves bill to curb hospital sticker shock

By: - February 25, 2020 8:01 am

Lawmakers Wednesday sent a bill to the governor’s desk intended to take the shock out of so-called surprise billing, charges bill that typically come from an out-of-network anesthesiologist, radiologist or other out-of-network specialist working at a patient’s in-network hospital. the_burtons/Getty Images

An end of “surprise” medical billing in Georgia could be in sight, as the state House and Senate coordinate plans on how to help patients avoid sticker shock from unforeseen out-of-network care.

Nobody likes to get eye-popping medical bills for treatment they thought their insurance covered, but measures to stop it from happening have for years fallen apart in the state Legislature. 

State Sen. Chuck Hufstetler got a unanimous 54-0 vote Monday followed by applause for his Senate Bill 359.

“It says that in an emergency situation, the consumer, the patient, will not be given a surprise bill,” the Rome Republican said on the state Senate floor Monday. “It will be worked out between the insurer and the provider.”

The typical “surprise” bill comes from an out-of-network anesthesiologist, radiologist or other specialist who’s working at a patient’s in-network hospital. The bill can be large enough to bankrupt patients. 

The legislation is “totally about the consumer,” Hufstetler said.

If it’s not an emergency hospital visit, under Hufstetler’s bill, the hospital would be required to give a written notice of any out-of-network physicians involved in the patient’s care and the estimated cost. 

Hufstetler said if he can pull it off, he would like to move up the start date, now set at July 1, 2021.

A few hours after the Senate vote, state Rep. Lee Hawkins brought the same language to a House committee as a substitute to his House Bill 888, which barely passed committee last week. Support for its supposed coverage shortcomings were enough to get it sent back for more work. 

Hawkins, a Gainesville Republican, said he and his counterparts in the state Senate are trying to keep in step, and not pile on complicating amendments, especially at the last minute. That risks confusion and repeating years of failure. 

“For five years, we’ve been losing this. So this is narrowly focused on surprise billing,” Hawkins said, pointing to a copy of the legislation.

The bill calls for the creation of a database which will list the typical price for many procedures. So instead of a specialist surprising a patient with a bill for thousands of dollars, the specialist will send the insurer an invoice for the typical covered price of that procedure as listed in the database.

It takes money and time to set up a state database as envisioned in the bill. So in the meantime, Hufstetler said, data will come from a narrower Medicaid database of procedure prices.

One idea left on the cutting room floor is a proposal to require 48 hours’ advance notice to someone who’s getting out-of-network treatment at an in-network hospital. The legislation only provides for unspecified “advance” notice. 

The Medical Association of Georgia, a physicians’ group, is broadly supportive of the language, said its government relations director, Derek Norton. He said they’re looking for a few language clarifications that will not change the intent of the bill. 

If it passes, their next step is to track the numbers put into the state database and to ensure the listed prices are fair from the association’s perspective.

From the Senate floor, Hufstetler said the bill has buy-in on the bill from groups representing hospitals, doctors and nurses, as well as the office of Gov. Brian Kemp.

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Maggie Lee
Maggie Lee

Maggie Lee is a freelance reporter who's been covering Georgia and metro Atlanta government and politics since 2008. Her written work and data journalism has appeared in online and print outlets including The (Macon) Telegraph, Creative Loafing and SaportaReport.com.

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