May 21, 2020

State Legislatures Take Varied Approaches to Address Surprise Billing

Three states will hold hearings on bills prohibiting out-of-network billing and requiring good faith estimates.

In Louisiana, the House Insurance Committee passed HB 283. The bill would prohibit out-of-network billing and would define reimbursement for out-of-network facility-based providers.

If there are no in-network providers at the facility, the amount billed or collected by the facility-based physician would be equal to or less than the median amount paid by the carrier to in-network providers for the same or similar services provided in the same parish as the base healthcare facility.

The facility-based physician would be prohibited from billing, attempting to collect from or collecting from an enrollee, other than the coinsurance, copayments, deductibles or other amounts identified by the carrier, on an explanation of benefits as an amount for which the enrollee is liable. The physician would also be prohibited from billing for services above the in-network rate for similar services at the facility.

In Missouri, HB 2589 was referred to the House Insurance Policy Committee. The bill would mandate healthcare facilities to require that each healthcare provider participate in the same health carrier networks as the healthcare facility. If a provider does not participate in the same health carrier networks as the facility, the provider would accept the health carrier's in-network rate and would be prohibited from billing the patient for any difference between the in-network rate and the provider's billed charge.

In Ohio, the House Health Committee was expected to hold a hearing on SB 97. It would require hospitals, on the request of a patient or the patient's representative, provide a reasonable, good faith estimate of the cost for each healthcare service that a patient or the patient's representative has scheduled at least seven days before the service is to be provided.

If known to the hospital at the time the estimate is provided and the patient is insured, the estimate would inform the patient whether the hospital or healthcare provider who will treat the patient is in- or out-of-network.

However, the estimate would not have to be provided in the timeframe indicated above, if the hospital submits a request to the patient's carrier for the information necessary for it to prepare the estimate, and the carrier fails to provide that information during the period consisting of the forty-eight hours immediately after the request is submitted to the health plan issuer.