Legislation aimed at protecting Georgians with health insurance from surprise out-of-pocket medical expenses passed the Senate Tuesday, 52 to 0, to beat the Crossover Day deadline.
Thursday is the deadline for bills to cross over from one chamber to the other in order to remain alive for consideration.
Sen. Chuck Hufstetler, R-Rome, said his SB 56 is designed to keep the consumer out of the mix when there is a price dispute between an insurance company and an out-of-network medical service provider. Currently, the balance is charged to the patient, who could end up thousands of dollars in debt.
“What this bill does is, it gives transparency to consumers,” he said Tuesday in presenting the legislation on the Senate floor.
Hufstetler said 90 percent of surprise bills stem from emergency care — for a trauma or sudden onset of a medical condition that appears to require immediate treatment. A formula in the bill would determine what the insurer must pay the provider, with the patient’s share limited to the in-network cost.
“For those (instances) that aren’t part of emergency situations, it sets up a dispute resolution process,” he explained.
A secondary consideration was to overcome so-called “narrow networks,” where the number of service providers in a patient’s coverage network is limited.
In many cases, it’s due to an under-served location. In others, it’s because physicians opt out. During the committee hearing, physicians said insurance companies don’t want to pay what a service is worth and insurers contended medical providers want to charge as much as they can.
“A University of Pennsylvania study says Georgia is No. 1 in the country for narrow networks,” Hufstetler said. “What we’re trying to do is provide a pathway where both providers and insurers have incentives to get those providers in network and keep the consumer out of the situations, even when it’s not an emergency.”
During the pre-vote question period, Sen. Renee Unterman, R-Buford, noted that lawmakers have been trying to address the issue for several years. House and Senate bills moved last year but neither passed both chambers.
SB 56 still has a rocky road ahead.
Hufstetler said he amended his bill after it passed out of committee last month at the urging of lawmakers who wanted to see more of a compromise between insurers and providers. He worked with the opposing sides for several days, he said, to resolve as many disparities as possible.
There’s a full page of amended language in the version that passed the Senate but he’s still expecting pushback in the House, where it’s been assigned to the Insurance Committee for review.
“We made a lot of compromises to the insurance providers,” Hufstetler said. “I believe this bill will pass overwhelmingly if it gets to the House floor. But to get past the insurance chairman, I think there still has to be some compromise made on payment methodology.”
The committee chairman, Rep. Richard H. Smith, R-Columbus, was the sponsor of the House bill that stalled last year.
The main elements would have required healthcare facilities to disclose out-of-network providers and their fees if a patient asks in advance of a scheduled procedure. It also would have required balance bills to be submitted within 90 days and contained a dispute resolution process.