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- When provider directories are out-of-date, and consumers are ill-informed about which providers are actually in their network.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).
Senator Renee Unterman (R-Buford) introduced two pieces of legislation to address surprise medical bills during the 2016 Legislative Session, and she prefiled Senate Bill 8 in advance of the 2017-2018 Legislative Session. On January 23, 2017, Representative Richard Smith (R-Columbus) filed House Bill 71. Both bills would protect Georgia consumers from surprise out-of-network medical bills. Georgia Watch supports this legislation and thanks them for their efforts.
Legislation Status: HB 71 passed out of the House Insurance Committee on February 17th but did not receive a vote from the full House before the Crossover Day deadline. SB 8 passed the full Senate on Friday, February 24th. A substitute to SB 8 passed out of the House Insurance Committee on March 20th and passed out of the House Rules Committee on March 22nd. SB 8 did not receive a vote from the full House before the end of the Legislative Session. Instead, House Resolution 745 passed. This resolution creates a study committee that will convene to examine the issue of unexpected out-of-network medical bills in the 2017 off-session.