Georgia Watch supports surprise billing legislation to protect Georgia consumers from unexpected out-of-network medical costs in an emergency or during a planned procedure.
A surprise medical bill can occur when an insured consumer inadvertently encounters out-of-network providers at an in-network facility during the course of their care. The consumer is then responsible for the excess medical costs – which can amount to thousands of dollars. Surprise bills often occur in a hospital or ambulatory care facility where anesthesiologists, surgical assistants, emergency room or other specialty care providers are frequently contracted. These providers do not necessarily participate in all of the same insurance plan networks as the facility in which they work. Consumers may not receive advance notice that they could encounter an out-of-network provider or an estimate of what the cost of that care might be. Consumers could receive surprise medical bills in the following scenarios:
- When they seek care at an emergency room at an in-network hospital and are unaware that some of the contracted providers are outside of their insurance plan network.
- When they have a planned procedure at an in-network hospital and certain hospital-based providers involved in the procedure, such as anesthesiologists or surgical assistants, are outside of their insurance plan network.
- When lab work or ultrasound tests are sent to out-of-network lab companies or radiologists.
- When provider directories are out-of-date, and consumers are ill-informed about which providers are actually in their network.
States including New York, Connecticut, Florida, Texas and California have passed laws containing surprise billing protections for consumers, and a bill was recently considered in the U.S. Congress (HR 3770).
Past Georgia Legislation: Senator Renee Unterman (R-Buford) introduced two pieces of legislation to address surprise medical bills during the 2016 Legislative Session, and she pre-filed Senate Bill 8 in advance of the 2017-2018 Legislative Session. Representative Richard Smith (R-Columbus) filed House Bill 71 in January 2017. SB 8 passed the full Senate on February 24, 2017 but did not receive a vote from the full House before the end of the 2017 Legislative Session. A House study committee chaired by Representative Smith convened throughout 2017 to examine the issue of unexpected out-of-network medical bills, and Georgia Watch provided testimony.
2018 Georgia Legislation: Representative Richard Smith filed House Bill 678 at the start of the 2018 Session. HB 678 is a transparency focused bill, and you can see recent news coverage about the legislation here. HB 678 passed the House of Representatives on Monday, February 12, 2018 and now goes to the Senate. Senator Chuck Hufstetler (R-Rome) filed Senate Bill 359 on January 26, 2018. Georgia Watch supports SB 359 because it protects consumers from out-of-network bills in emergencies and establishes an arbitration process that is available to consumers if unexpected out-of-network bills arise during scheduled procedures. Senate Bill 359 unanimously passed the Senate on February 28, 2018 and now moves to the House.