These United States are alive with the sound of legislators trying to hammer out solutions to the rampant balance billing crisis. While a national solution has its proponents, in the absence of a national statute, the states have been very busy doing what they can. Here are recent developments:
A bill from Insurance Commissioner Mike Kreidler that sought to help consumers avoid balance bills has failed. Had it passed, Engrossed Substitute House Bill 2114 would have prevented surprise medical or ‘balance’ bills when an in-network medical facility was used, but treatment was provided by an out-of-network provider. The bill passed the House of Representatives but failed the Senate.
On March 1, Oregon’s House Bill 2339 went into effect to protect consumers from receiving surprise out-of-network medical bills from healthcare providers. The new law prevents providers who were not proactively chosen by the consumer from balance billing for their services.
Additionally, the law requires healthcare providers to inform consumers about the increased financial responsibility when choosing services from an out-of-network provider.
Patients receiving services from out-of-network providers may still be responsible for co-insurance, co-payments, or deductibles. Consumers can still choose an out-of-network provider, and when they do, those providers can still balance bill consumers for that choice.
New Jersey legislators are working this month on details of AB 2039, The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act. The bill would protect consumers from getting charged for surprise out-of-network medical expenses. Lawmakers have had to re-introduce the bill several times over the last nine years as healthcare providers, doctors, insurance companies and consumer protection groups have been unable to come to agreement on how to reduce balance billing.
As we’ve written about before, other states, including New York and California, have laws in place to protect consumers from getting billed for things such as an unexpected medication or a consultation from an out-of-network specialist during surgery.
A bipartisan measure, New Hampshire HB 1809, drafted to protect patients against balance billing, got a strong endorsement from the House this month, passing with a 326-5 vote with no debate. One of its co-sponsors, Rep. Dave Luneau, has been trying to get a bill that would outlaw balance billing to the House floor for several years. If it passes the Senate and is signed into law, this bill will prevent consumers from being responsible for unexpected out-of-network bills for care they receive at in-network hospitals. It requires hospitals and insurers to deal with billing discrepancies on their own, without involving consumers. When hospitals and insurers reach an impasse, they can ask the insurance department to weigh in. The New Hampshire Insurance Department, which typically remains neutral on legislation, took the rare step of endorsing HB1809. However, like many other balance bills under consideration in other states, the NH bill has drawn the ire of hospital and physicians’ groups, who argue it will limit flexibility and gives too much leverage to insurance companies. The bill will now proceed to the Senate. A related bill, HB1643, was killed in the NH House this month as well.
Virginia HB 1584 prohibits an out-of-network healthcare provider from charging a covered person who is insured through a health benefit plan an amount for “ancillary services” greater than what the insurance carrier would be obligated to pay for the insured. Included in the definition of ancillary services under this bill are screening, diagnostic and lab services that are part of the care a covered person receives from, or at, an in-network provider. In-network providers will be required to provide certain notices regarding the provision of ancillary services by an out-of-network provider. The measure has a delayed effective date of Jan. 1, 2019.