Physician, hospital and insurer groups each expressed concerns Tuesday about Georgia Senate legislation that aims to prevent “surprise billing’’ of patients, but perhaps the most compelling testimony came from a legislator’s wife.
The Senate Health and Human Services Committee heard testimony on a proposal to halt these medical bills, which can come from ER doctors, anesthesiologists, radiologists, pathologists and others who are not in a patient’s insurance network — even though the hospital where they work is.
Vicki Willard, wife of Rep. Wendell Willard, a Sandy Springs Republican, testified that in August, she went to Emory Saint Joseph’s Hospital after experiencing numbness in her cheek and arm.
She knew St. Joseph’s was in her insurance network. “I’m an educated advocate for my health care,’’ she told the panel.
But four weeks after her treatment there, Willard said, she received an unexpected $700 bill from a cardiologist.
This KHN story can be republished for free (details).She then called her insurer. The first cardiologist who had seen her, she found out, was a network doctor. But a second cardiologist — the one who sent her the bill — wasn’t in her network, even though that doctor was in the same medical group as the other doctor.
“I have absolutely no control over that,’’ Willard said. “That’s extremely frustrating.”
Sen. Renee Unterman (R-Buford), a nurse who chairs the panel and sponsor of Senate Bill 8, said health insurers and medical providers can’t agree on a solution to the “complicated issue.’’
“It’s like putting cats and dogs in a room,’’ she said. “The one that suffers the most is the consumer.”
Beth Stephens of Georgia Watch, a consumer watchdog organization, said issues with medical bills were the No. 1 reason why consumers called her organization in 2016.
The two current proposals on surprise billing — Unterman’s in the Senate and one in the House — call for greater transparency about which doctors are in an insurer’s network and an estimated cost of the procedure.
The Unterman proposal would also create a database of reasonable charges for a procedure. If a bill is disputed, the insurer and doctor would have to work out a resolution.
“I have tried my best to be fair,’’ said Unterman. “To listen to both sides.”
Representatives from the insurance industry said that one database of rates that Unterman’s bill would use, Fair Health, should not be used as a benchmark for reimbursements because it’s too high.
Physician organizations have said they support Fair Health, and blamed “narrow’’ insurance networks for many instances of high non-network charges.
Hospital groups, meanwhile, said the transparency required to educate patients about network providers should be shared among hospitals, physicians and insurers.
Other states, including Florida, recently passed legislation to address the problem.
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