By Dusty Nix – Columbus Ledger-Inquirer
“Health care, as far as cost is concerned, is kind of like a black hole.” — State Rep. Richard Smith, R-Columbus
We’ve been here before. It’s not a place anybody ought to be, ever.
The unpleasant “surprise” of after-the-fact medical bills, some of them astronomical, for care that patients thought was covered by their insurance has become one of the burdens of a health care establishment that is outrageously burdensome already.
It goes like this: You check into a hospital in your health care network for a procedure involving physicians and procedures that you know are covered by your health plan. But at some stage or stages in the process, unbeknownst to you the patient/client/customer, specialists or procedures not in your coverage plan or network are involved. And a few days or weeks later, when you’re supposed to be convalescing, the “surprise” arrives in the mail. Its effect might not be, well, healthy.
As we noted in an editorial last March, Smith’s original 2017 bill called for any doctor who is certified to work at a particular hospital or other health care facility to be certified under all that facility’s network plans. It’s a good idea from the standpoint of patient protection: The patient would be indemnified against an out-of-network specialist submitting a separate bill for uninsured care later on.
Emergency patients are even more vulnerable: People with acute health problems or traumatic injuries don’t have the luxury, if you could call it that, of making sure everybody who might be involved in saving their lives is covered by their insurance.
That bill passed in committee, but didn’t beat the Crossover Day deadline late in the legislative session.
A 2017 Senate bill offered an alternative: Patients scheduled for medical procedures would have to be informed of anyone involved who is not in the insurance network, and the bill also provided a reimbursement plan for out-of-network doctors in emergency situations.
The Medical Association of Georgia opposed that plan because of concerns about reimbursement levels; Georgia Watch, a consumer organization, supported it on the grounds that protection for emergency patients was the key provision.
Smith’s new legislation, House Bill 678, is basically an informed consent bill: It says patients who schedule medical procedures have a right to know in detail what medical professionals will be involved, what insurance will and won’t cover, and what the bottom line will be.
“You go to a hospital and have a scheduled procedure and you think your insurance covers everything,” Smith told the Macon Telegraph, “and then all of the sudden you get a bill in the mail for $500, $5,000, $10,000.” One Columbus patient, Smith said, was hit up for $15K.
Smith’s bill is pending, and the proposal that doctors be required to join all insurance networks of hospitals where they practice is still on the table, the Telegraph reports. No response yet from MAG or other professional groups. Let the debate resume.
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Source: Columbus Ledger-Inquirer