Proposed legislation requested by Insurance Commissioner Mike Kreidler and sponsored by Rep. Eileen Cody would end ‘surprise’ bills for out-of-network emergency care that can leave patients with unexpected debt.
Washington Insurance Commissioner Mike Kreidler has proposed new legislation to end so-called “surprise” medical bills for emergency care that can saddle patients with hundreds or thousands of dollars in unexpected debt.
It’s a move supported by patients like David Moulton, 59, of Seattle, who said he was charged more than $700 in out-of-network fees when he sought emergency care in 2012 for what turned out to be leukemia. The hospital was covered by his health insurance, but the doctors in the ER were not, he said.
“I think if they are going to do business in a hospital, they need to honor what that hospital does,” he said. “How am I gonna check an ER doc? How am I gonna check an anesthesiologist?”
It’s especially true in an emergency situation, he added: “That is the farthest thing from your mind, plus you might not even be conscious to ask.”
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House Bill 2447, requested by Kreidler and sponsored by Rep. Eileen Cody, D-Seattle, would ensure that patients pay only expected charges — including copays and deductibles — for emergency care. If there’s a dispute about contracts or out-of-network fees, the problems would have to be worked out with the insurer and the provider or hospital.
“Our bill is straightforward: It takes the patient out of the equation,” Kreidler said in a statement.
More than a dozen states already have laws that address what’s also known as “balance billing,” which occurs when providers bill patients for the difference between what insurance pays and what doctors and others charge.
The proposal likely will face stiff opposition from the Washington State Medical Association, emergency-care doctors and others during a public hearing before the House Health Care and Wellness Committee on Wednesday.
“Health-care providers should retain the right to bill for services provided,” Dr. John Matheson, president of the Washington chapter of the American College of Emergency Physicians (WA-ACEP), said in a letter to Kreidler’s legislative liaison last month.
Instead of a new law, Kreidler should effectively interpret and enforce current law as written, the WA-ACEP said.
Results of a survey by Consumers Union, a patient-advocacy group, released Tuesday showed that one in three Washington state residents with private insurance had received a surprise medical bill where their health plan paid less than expected in the past two years.
And 14 percent were charged an out-of-network rate when they thought their provider was in-network, according to the survey of 367 residents.
But Nathan Schlicher, a Tacoma ER doc and president-elect of the WA-ACEP, said Consumers Union uses a definition of “surprise” billing that is far too broad and includes any instance in which a patient simply didn’t expect the costs charged.
In fact, he said a review of 750,000 patient visits at 45 Washington hospitals last year found that less than 3 percent of ER patients receivedbills for the difference between treatment costs and insurance coverage — and only a tiny fraction were for fees above $250.
Few complaints about the issue have been filed with Kreidler’s office, said spokesman Steve Valandra. That could be because consumers aren’t aware they have recourse, he added.
The new legislation would offer insurers only two options: Pay the fees or send it to binding arbitration, critics said. That could unfairly penalize the doctors, Schlicher said.
“We believe that the issue should be studied … before we rush into legislation that could unbalance this in either direction,” he said.
But those who’ve paid the extra costs say the top priority should be protecting patients from being billed for services that insurance should have covered.
“While my experiences have not been huge dollar amount issues they could be,” said Moulton, the Seattle man whose leukemia is now in remission.
The hearing begins at 1:30 p.m. Wednesday in House Hearing Room A in the O’Brien Building at the state Capitol in Olympia.