ATLANTA – The Georgia House of Representatives overwhelmingly passed legislation Tuesday aimed at ending “surprise billing” in Georgia, unexpected medical charges that can add up to thousands of dollars and bankrupt families.
The bill primarily would affect unexpected bills for services a patient receives at a hospital inside their insurance plan’s network from an out-of-network specialist such as a radiologist or anesthesiologist. The Georgia Senate unanimously passed similar legislation last week.
However, the version of the bill the House approved 164-4 on Tuesday also would apply to emergency services a patient receives from a hospital outside of his or her insurance plan’s network, said Rep. Lee Hawkins, R-Gainesville, the House measure’s chief sponsor.
“It cleans up a lot of in-network and out-network obstacles for the patient,” Hawkins said.
Both the House and Senate bills would require insurance companies to pay out-of-network physicians either a contracted amount based on rates charged in 2017 for various procedures, or a higher charge the patient’s insurance company proposes.
Disputes between the insurer and provider would trigger an arbitration process overseen by the state Department of Insurance, which would contract with outside arbitrators to decide the final bill.
Lobbyists for Georgia insurers, hospitals, physicians and consumer advocates have been working for five years to come up with language all sides could agree on. Hawkins said House Bill 888 is the result of those efforts.
Also on Tuesday, the House passed a second measure addressing surprise billing. The legislation, which passed 170-1 and now moves to the state Senate, would set up a rating system patients could use to determine which physician specialty groups in their insurance plan’s provider network serve a given hospital.
“We’re trying to shed a light of transparency on these plans,” said Rep. Mark Newton, R-Augusta, chairman of the House Special Committee on Access to Quality Health Care and the bill’s chief sponsor.
Newton’s bill would apply to anesthesiologists, pathologists, radiologists and emergency room doctors, the specialists typically responsible for the most cases of surprise billing.
Under the legislation, when an insurance company advertises a hospital as in its coverage network, the insurer would have to disclose that hospital’s “surprise bill rating.” If that rating is less than four, the insurer would be required to disclose which of the four specialties are not in its network.