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Guest MINDSETTER™ Archambault: Surprise Billing Can be Financially Disastrous to Patients

Friday, March 25, 2016


There’s a new medical epidemic that’s sweeping the country — one not caused by viruses or bacteria. And it can hit anyone at any time.

The epidemic is called “surprise billing” and it happens when a patient goes to a hospital or emergency room that his health insurance considers “in-network” only to find out later that doctors aren’t necessarily hospital employees and aren’t covered by the same insurance. Often times, emergency room doctors, anesthesiologists, pathologists and radiologists are employed by an independent company that contracts with the hospital.
Since some insurance plans offer little to no out-of-network coverage, patients can get hit with all sorts of surprise bills that are considerably higher than what they were led to believe they would be charged.
This practice puts a great responsibility on the patient, who may be in no condition to bargain or shop around, to know who exactly is providing care — even in an in-network medical institution. But it’s not an easy task to find out the network status of every last health care provider a patient comes in contact with — especially considering the health and emotional state of a patient seeking health care. A patient could be lying on a gurney totally unaware that all the people in lab coats who show up at the bedside may be charging them for services. So most patients don’t realize this practice is a reality — until they get the bill. And the charges can be twice as much, even up to 10 times as much as they expected.
As health insurance networks start getting narrower and narrower as insurers and employers try to cut their costs, this problem is just going to get worse and worse.
So the question remains: what can we do about this? Well, it’s time for the law to address this practice — and be as fair as possible not only to patients, but to insurers and health care providers. A couple of states, New York and Connecticut, already have some protections in place. Tennessee is working on legislation that would require hospitals to notify patients if any scheduled procedure is to be provided by an out-of-network provider. They would even have to give an estimate of the charges.
I’ve submitted legislation (2016-S 2462) that looks to address these problems by providing for a dispute resolution process for emergency services and surprise bills for medical services that are performed by out-of-network health care providers. The legislation would require the health insurance commissioner to establish the process by which these disputes are handled.
The surprise charges can be especially significant because they may involve out-of-network providers who bill 20 to 40 times the usual local rates and often collect the full amount, or a substantial portion. This legislation would curb that practice by establishing a vehicle by which these surprise fees can be disputed and resolved.
It is imperative that this issue be addressed immediately, and that’s what this legislation looks to do. Because surprise, out-of-network charges are getting out of hand.

The author, Stephen R. Archambault, is a Democratic state senator representing District 22 in Smithfield, North Providence and Johnston. He resides in Smithfield.


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