Change to surprise billing measure gains ground but draws criticism

The legislative tug-of-war over surprise medical billing continued Thursday as a House panel approved a new version of a Senate bill that aims to curb these unexpected charges to patients.

The vote on Senate Bill 56 came as lawmakers were taking action on several health care proposals over the past couple of days.

What’s known as surprise billing refers to instances in which consumers have procedures or visit ERs at hospitals in their insurance network, then receive separate bills from non-network doctors involved in their care. These unexpected charges can amount to hundreds or even thousands of dollars.

Such bills can come from ER doctors, anesthesiologists and radiologists, among others. They can enrage patients, who often feel misled and blindsided.

Several states have passed legislation to reduce such charges.

The battle over how to solve the problem in Georgia has gone on for years. But each time the issue of surprise billing has been raised under the Gold Dome, the dispute has ended in a stalemate, with some legislators supporting insurer-backed measures and others lining up behind proposals favored by physicians.

On Thursday, a subcommittee of the House Insurance Committee approved a substitute to Senate Bill 56 that requires transparency for patients on the medical charges they face.

Medical providers, if asked, would have to give patients information about which doctors will be involved in a non-emergency procedure, whether they’re in the patient’s network, and what the resulting fees would be.

That was the thrust of House Bill 84, sponsored by Richard Smith (R-Columbus), chair of the House Insurance Committee. His bill, though, failed to pass the House.

The new conflict, over the reworked bill, stems from provisions about payments to non-network doctors.

The original Senate version proposed a payment rate for emergency services that would calculate insurers’ payment to non-network medical providers using a formula that would include a “benchmarking” database as a reference point.


But the substitute bill says that for emergency services, medical providers who are out of network would be reimbursed the equivalent of the relevant Medicare payment, or the average contracted amount, whichever is greater. And the consumer, the legislation says, could not be billed for an amount higher than the co-pay, co-insurance, deductible or other cost-sharing amount of the individual’s health plan.

The sponsor of the Senate bill was clearly not happy with the changes. Sen. Chuck Hufstetler (R-Rome) told the subcommittee members that the new version would penalize medical providers, perhaps driving some out of the state.

The bill’s prescription for payments to doctors ‘’clearly won’t work for the providers,’’ he told the House subcommittee. “We’re still trying to work on a [payment] number that would be reasonable.”

Georgia already “is the No. 1 state for narrow networks,’’ Hufstetler said, referring to health plans that offer a limited choice of health care providers in exchange for lower premiums.

“The main thing is that we need to get the consumer out of the middle’’ of insurer-doctor payment disputes, he added.

Subcommittee Chairman Darlene Taylor, a Thomasville Republican, said the panel felt that it needed to act.

“We feel we need to move this forward,’’ she said. “We all need a settlement of this issue.’’

Physician groups testified against the payment metric created in the bill. “Medicare is a poor standard to inject into the private market,’’ said Jet Toney, lobbyist for the Georgia Society of Anesthesiologists.

An insurance industry group, the Georgia Association of Health Plans, said it supports the new version of the legislation.

Laura Colbert of the consumer group Georgians for a Healthy Future said, “It is encouraging that legislators have not given up on finding a solution to surprise medical bills.’’

“After more than four years of debate on this issue, Georgians deserve relief and expect a solution,’’ she said. “Further delays in passing meaningful legislation would only punish consumers further.”

Earlier Thursday, the state Senate unanimously approved the creation of a state commission to analyze Georgia’s behavioral health services and recommend improvements.

The commission would be authorized to take ‘‘a very deep dive’’ into the state’s mental health system, Rep. Kevin Tanner (R-Dawsonville), lead sponsor of House Bill 514, said recently. He said Gov. Brian Kemp, Lt. Gov. Geoff Duncan and House Speaker David Ralston (R-Blue Ridge) have all worked on the commission proposal.

Late Wednesday, the Senate Judiciary Committee passed a bill that aims to protect tenants from retaliation by a landlord after they file a complaint about unhealthy conditions.

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House Bill 346 is sponsored by Rep. Sharon Cooper (R-Marietta), chair of the House Health and Human Services Committee, who told the Senate panel that unhealthy housing conditions are “a very serious health care problem in this state.’’

“Many of our children are poor and live in substandard housing,’’ Cooper said, pointing out that mold in residential areas can worsen children’s asthma. She said 41 states have similar protections as those envisioned by the proposal.

In other committee action Wednesday, the Senate Education and Youth Committee approved House Bill 83, which would require recess for Georgia elementary school students. Advocates say recess, by providing opportunities for physical activity and exposure to the outdoors, can improve pupils’ health and academic performance.

The proposal, which has died in previous legislative sessions, now heads to the Senate Rules Committee.