Some health insurance good news, maybe?

Sen. George Barker and Del. Mark Sickles have teamed up to introduce legislation that seems to be good for consumers.  SB 767 and HB 901 tackle the very annoying practice of “surprise” or “balance” billing.  This is what happens when you go into surgery, planned or emergency, and your hospital and doctor are in your insurance network, but the anesthesiologist is not. So, when you get your bill, there is a great big charge for the anesthesiologist.

As the legislators explain in an op-ed in today’s RTD, under the terms of the legislation “the out-of-network providers would be fairly compensated at a rate established at the lower of the median amount that in-network providers would receive, or 125% of what Medicare would reimburse for that service.” I think the patient would still be liable for any co-pays or deductibles.

I have read the bill and it seems favorable to us regular consumers of health care, but my eyes and brain have always tended to glaze over when confronted with legislation dealing with insurance. If anyone out there checks it out and finds that there is some catch in it that makes it not so favorable, please let us know.

— Dick Hall-Sizemore

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9 responses to “Some health insurance good news, maybe?

  1. Good post. Out of network warps the system and plays into the hands of Big Med. they pretend to give you a choice but the system is gamed to give you no info. And, if it’s an emergency, you can’t shop around

    • I watched the bill being presented yesterday, but there is just this flood of stuff to cover and I have to pick and choose. I want to go sit down with Sickles, because of all the balance billing proposals his has the broadest support, but the docs and hospitals hate it because they want more $$$$.

    • Agree with your sentiments, PG; and SH, your analysis of the reaction seems like a plus for consumers to me. Wealthier patients may hate these surprise billings but there are some for whom it’s far worse than a surprise. That doctors would seek to impose such charges anyway says to me (1) the system for negotiating “in network” status for key specialists is broken, or (2) it’s not broken at all but too many docs simply won’t agree to the principal networks’ reasonable restrictions and are blind to how deeply upset patients are when blindsided. Then again, maybe (3) the hospitals themselves are making it too easy for out-of-network professionals to take part in what they portray as “in-network” procedures. Thanks to the incredibly opaque health care system we have inflicted upon ourselves, the average patient has no idea who’s to blame, just wants it to stop.

  2. This feels very pro-consumer by putting responsibility on the insurers to pay, and on physicians to work out billing with insurers.

    Mechanically, insurers win here, and independent physicians lose. 1. It reduces upside for independent providers to stay out of network, thus reducing their leverage with insurers. And 2. Creates incentive for independent providers to join big physician grips who have the ability to extract greater than median/125% rates.

    Quotes from Richard Suczs in attached article do a great job highlighting this, though I’ll admit to little sympathy for his margins. https://www.google.com/amp/s/wtvr.com/2019/12/03/hipolit-balanced-billing-psi/amp/

  3. I read the newspaper article. The bill is just more market distortion and price-fixing by the government. When I get more time and can find the article I will comment further what they really need to do is do away with the certificates of need. That does more to distort the market than anything.

  4. This particular thing – surprise billing –

    what’s a good fix for it besides a govt rule?

    How about prescription drugs – what’s a good non-govt solution?

  5. Acbar you are right. This is a nationwide problem and folks are looking for a nationwide answer, too. It’s really tough to expect a sick or injured person to ask every provider – especially within a facility that they know is included in their insurance – if they accept their insurance. There’s got to be a better way. It should not be acceptable to dump responsibility on the consumer who has no good way to protect him/herself. The system is badly broken. It may not be fixed without states taking action and trying some things.

  6. VCA I agree, the system is broken — but what aspect of it? Our health care system is so opaque no one can tell, not even those immersed in it. Larry, yours is a very challenging question, which Jim really should take up. The short of it is, markets cannot be the solution without transparency, but transparency alone won’t make a market work. First, transparency! That at least allows the experts to figure out what is really wrong. I’m not saying that exposing costs and pricing and cross-subsidization (for example, of free health care for indigents through overpricing to a hospital’s insurance patients), and transparent (but unequal) exercise of market power in negotiated pricing of medical professionals’ services, could bring about a fix of what’s wrong here, but at least transparency would provide a clue where to start.

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