A Georgia legislative panel hearing Thursday reviewed the issue of surprise billings for medical care.

“Balance billing" occurs when a hospital, physician or other health care provider sends a bill to a managed care patient after the patient’s health insurer has paid its share. The patient owes the balance and large bills can occur when an out-of-network provider charges a patient an out-of-network rate, usually higher than the rate that in-network providers charge. 

The issue of surprise billings can confound consumers and lead to difficult collection practices.

State Sen. Renee Unterman, chair of the Senate’s Health and Human Services Committee, chaired the panel subcommittee. She said many of her constituents complain regularly about medical debt, specifically bankruptcies resulting from medical bills and credit rating downgrades, according to an article by Georgia Health News and Kaiser Health News. 

Physicians and members of the hospital and insurance industries testified on the issue of surprise billings and pointed to several reasons for their use. Hospitals generally aren’t aware of what health plans physicians belong to, said Donna Hatcher of the Georgia Hospital Association, nor do hospitals have any control over the rates paid to doctors who aren't employed by the hospital.

Hatcher told the subcommittee that medical providers often have no choice but to bill the patient for the balance. A recent trend toward more limited insurance networks has created more opportunity for surprise billing, she added.

Leanne Gasaway, with industry trade group America’s Health Insurance Plans (AHIP), said surprise bills aren't caused by inadequate networks, as many argue. They’re often triggered when a medical specialist is brought in to assist in a patient’s care and that physician isn't in that patient’s network, she said. AHIP officials said out-of-network providers can charge a consumer whatever rates they choose. Gasaway said the problem is getting worse and has created a serious consumer protection issue.She cited a system that would pay reasonable and fair amounts to non-network providers and create a dispute resolution process as key possible solutions to the issue.

According to the Kaiser Family Foundation, more than a dozen states have passed laws aiming to protect managed care patients from exorbitant balance billing.

Nationwide, in 2014, hospital patients felt an increased financial burden as medical costs rose while revolving credit became less available, according to a TransUnion Healthcare Report released in April.

"We are finding that the healthcare providers that have been the most flexible in adjusting their billing practices also appear to have performed best during these transitional years," said Gerry McCarthy, president of TransUnion Healthcare. "A key change in the industry is the increased prominence of upfront cost estimates and more timely and transparent healthcare bills."


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