The House narrowly passed a bill 36 to 22 on Wednesday to protect patients from getting huge, surprise medical bills when they unintentionally and/or unexpectedly receive care from a provider not covered by their health insurance plan.
Rep. Rob Nosse, D-Portland, said consumers currently can see bills as high as $8,000 when they use a hospital covered by their health plan but get an anesthesiologist or radiologist who’s not covered by their particular health plan. Whatever the insurer doesn’t pick up, the provider will bill to the patient, sometimes sending patients to collections if they refuse to pay.
About 300 people have complained to the state insurance division over the past three years about the current situation, and providers testified that it affects about 3 percent of their patients.
“This is more common than you might think,” Nosse said. “That’s a lot of money for a consumer, especially for something that’s not planned.”
Often, providers are unaware that they are not in the patient’s health insurance network, since some plans offered by insurers are more limited than others, and a provider may be on the insurer’s gold plan but not its silver plan, for example.
House Bill 2339 attempts to correct this problem by requiring health insurers to pay providers a rate that is 1.75 times the payment allowed by Medicare. Out-of-pocket costs for consumers would be the same as if they saw a provider that was included in their insurance contract. Providers could no longer send a bill to the patient, even when they are unhappy with the amount they receive.
The bill also addresses emergency services, since patients often have no choice but to go to the nearest hospital, regardless if it’s in in their insurance network. In those cases, the hospital would be paid based on the average payments they receive for the care provided through private insurance or the Medicare rate, whichever was greater. Hospitals in these situations would similarly be stopped from going after patients for additional payment.
Rep. Julie Parrish of West Linn was the only Republican to join all 35 Democrats to approve HB 2339.
Other Republicans, led by physician Rep. Knute Buehler, R-Bend, said they wanted to solve the problem for consumers but they objected to this solution.
“It is a problem that we all recognize and it needs to be fixed. Surprise billing needs to be stopped,” Buehler said. “[HB 2339] gives incredible leverage to insurance carriers to bid down those who remain in-network.”
Buehler said that setting the rate too low would cause insurers to drive down the rate for all providers. He believes Medicare rates are arbitrarily set based on federal government budget restraints; often rates are unfairly low and don’t even cover certain procedures that private insurance covers.
Rep. Bill Kennemer, R-Canby, a retired psychologist, said many providers have been shut out of insurance networks because health insurers have built their business models around limited networks that reduce access to healthcare -- causing fewer customers to submit claims, and allowing insurers to keep more of their premium dollars.
“Medicare rates are very low … and it can be very difficult to get on those [in-network private insurance] panels,” Kennemer said. “Absolutely, this is an issue that needs to be resolved. … But this bill comes up short.”
But Rep. Mitch Greenlick, D-Portland, said it was difficult to strike that right balance between consumers and insurers who want to pay less and providers who want to get paid more. One amendment called for rates of 4 times Medicare -- which he said was way too high.
“It’s not a bill to bankrupt the provider. It’s a bill to fix this for consumers,” Nosse said.
After the vote, Buehler told The Lund Report that Nosse and Greenlick rejected a proposal he preferred, using the Fair Health index, which is set according to actual claims data compiled by a non-profit third-party company. He said he was willing to consider a compromise that set out-of-network payments based on customary payments instead of charges, which are often not set in reality.
Nosse and Greenlick rejected this compromise, as well as his attempts to set a higher rate than Medicare. He wanted 2.5 times Medicare -- an earlier compromise put the rate at 2.25 times Medicare, before it was eventually ratcheted down to 1.75 times Medicare.
Nosse, in his speech, said that fixing the cost to Medicare was transparent and simpler than using the private database. He said that state actuaries for the Department of Consumer & Business Services suggested the rate of 1.75 times Medicare. Greenlick conceded they may have pegged it to low: “175 might not be the right answer,” he said.
Buehler said he would continue to push for a better compromise as HB 2339 heads for the Senate.
Reach Chris Gray at [email protected].
