ATLANTA – Twin measures moving through the state legislature would ban the practice of “surprise billing” in Georgia, in which patients wind up with unexpectedly big bills months after hospital visits.
Republican lawmakers in the Georgia House and Senate have filed identical legislation that would remove Georgia hospital patients from the billing equation, leaving it to medical providers and insurance companies to work out their cost differences.
The legislation still faces pushback on how costs would be worked out between insurers and medical providers, but representatives from both sides agreed at a Senate Health and Human Services Committee hearing Tuesday that the finish line is close after years of debate over the issue.
“We really think it’s time to put this to bed and protect Georgians,” said Laura Colbert, executive director of the nonprofit Georgians for a Healthy Future.
Dubbed “surprise” or “balance” billing, the extra hospital charges result from specialty procedures like anesthesiology or emergency-room surgery completed by out-of-network specialists. They can add hundreds or thousands of dollars to a patient’s final bill without their knowing in advance.
State lawmakers have tried for the past five years to tamp down surprise billing, said Rep. Lee Hawkins, sponsor of the House legislation.
He and others traced hold-ups to disagreements over how insurers and medical specialists should settle out-of-network costs, particularly if disputes arise that need formal arbitration.
Medical specialists argue they are underpaid for performing complex technical procedures under in-network insurance arrangements, while insurers claim those specialists charge too much, Hawkins said.
Hawkins, R-Gainesville, said he just wants legislation to pass that will leave patients out of the haggling involved with hospital costs.
“The No.-1 thing is to make sure that there’s no more surprise billing,” Hawkins said. “Everything else is making sure it works with the providers and the insurers.”
Gov. Brian Kemp has thrown his support behind the bills, calling them “compromise legislation” worthy of passage.
“While there is more work to do,” Kemp said in a statement, “I am committed to working with the General Assembly, patients, providers and insurance carriers to pass this legislation and put patients first.”
Hawkins’ House Bill 888 and counterpart Senate Bill 359, by Sen. Chuck Hufstetler, would require that insurers pay out-of-network physicians either a “contracted amount” set in 2017 for various procedures, or a higher charge that the insurer proposes.
Disagreements between the two sides would prompt an arbitration process overseen by the state Department of Insurance, which would contract with outside private arbitration companies to decide the final bill.
All arbitration decisions and final payments would be logged in a database kept by the insurance department. That data would factor into annual rate adjustments for the contracted amounts that serve as a baseline for what insurers reimburse for out-of-network procedures, Hawkins said.
Those aspects of the bill – arbitration and the database – are critical because they would shed light on how much insurance companies actually pay providers for specialty services, Hawkins said.
“We never see exactly what the insurance company was paying the physician,” he said.
Some representatives for medical providers and insurance groups still want tweaks to the legislation, particularly on the finer points for how the contracted amounts would be set. They aired their suggestions at a committee hearing on Hufstetler’s bill Tuesday.
Victor Moldovan, an attorney representing the Independent Doctors Association of Georgia, said the 2017 baseline reimbursement rates may be too low for specialty providers to stay in business. He also called for distinguishing more between payments for emergency services and non-emergency services.
“At the end of the day, this is not a free cost,” Moldovan said. “There has to be a way to manage these issues … in a way that’s fair to not just the patient, but the providers as well.”
Some physician groups also want tighter rules on what kind of information would be logged into the new all-payer database, the details of which may end up being worked out in separate legislation.
No action was taken at Tuesday’s committee hearing.
Hawkins’ and Hufstetler’s bills are part of a slate of health-care measures filed in the 2020 legislative session that started last month. Other efforts include a bill by Sen. Dean Burke, R-Bainbridge, aimed at restricting how third-party companies can influence prescription drug prices in Georgia.
The surprise-billing legislation will likely see some changes as it winds through the Georgia General Assembly, Hawkins said. But state officials and lawmakers are determined to follow through on the issue this year, having framed surprise billing as a top priority in the session.
“If we do not get this solved, I think it would be a failure of the session,” said Senate Health and Human Services Committee Chairman Ben Watson, R-Savannah.