Hospital in Georgia
A worker is seen behind the registration window of the emergency room at Grady Memorial Hospital in Atlanta.
 

Georgia lawmakers have proposed a bill that could stop insurance companies from denying medical benefits for out-of-network services.

Senate Bill 293, dubbed the Balance Billing Consumer Act, includes 22 provisions aimed at securing fairer billing practices for patients. The legislation protects patients from what lawmakers call surprise bills. 

“We’re looking forward to healthy negotiations on legislation to stop surprise billing and ensure patients are not caught in the middle of price disputes between insurance companies and providers,” Georgia Senate Republican Caucus wrote on Twitter.

Surprise billing often occurs when patients receive a second invoice for services that were not covered by their insurance provider after a doctor or hospital visit.

Four in 10 insured Americans, 18 to 64 years old, say their family received a surprise medical bill over the last two years, according to Henry J. Kaiser Family Foundation's research.

An average of 13 percent of emergency visits in Georgia in 2017 resulted in at least one out-of-network charge, researchers found.

Patients may be routed to a medical provider for emergency treatment that is not included in their insurer’s network. Insurance companies may not pay for the services or opt to pay only a portion of the list price. The remaining balance is then billed to the patient also referred to as a “balanced bill.”

An average of 16 percentage of in-network inpatient admissions in Georgia resulted in at least one out-of-network charge in 2017, according to Kaiser's research.

HB 293 would require insurance companies to cover medical services whether or not the provider is in the insurer’s network. The out-of-network provider will then bill the insurance company directly, and the company must pay the provider the average amount it has paid for the “same or similar service.”

The Georgia Department of Insurance would review the bill prices and maintain an “all-payer health claims database” to keep track of pricing points. Insurers would also have the option to dispute the price point with the department with the use of an arbitrator.

The law also includes preventative measures.

If a patient is sent to an out-of-network facility for emergency services, the law gives health care providers the option to transfer the patient to an in-network facility once he or she is “stabilized.”

The bill’s primary sponsor, Sen. Chuck Hufstetler, R–Rome, could not be reached for immediate comment. But Hufstetler has made numerous attempts to pass legislation that blocks balance billing. 

“We’ll finally get the consumer out of the middle of these insurance problems,” he told the Rome News-Tribune.

About three-fourths of Americans want the federal government to impose balance billing protections, according to a recent Kaiser Foundation poll.

 

Staff Reporter

Nyamekye Daniel has been a journalist for three years. She was the managing editor for the South Florida Media Network and a staff writer for The Miami Times. Daniel's work has also appeared in the Sun-Sentinel, Miami Herald and The New York Times.