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Health Care

Legislation to End Surprise Medical Billing

Staff Contact

Wendy Block

Vice President of Business Advocacy and Member Engagement

(517) 371-7678 | wblock@michamber.com

Summary of Bill & What It Means to You

This legislation would lessen the impact of surprise medical billing.  Surprise billing occurs when a patient receives care from a physician who does not contract with their health insurer and is considered an out-of-network provider. The situation can leave patients with large medical bills when they receive care, often unknowingly, from a provider who is not part of their health insurer’s established network.

The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. The notice must inform the patient that a non-participating provider must provide them “a good-faith estimate of the cost of the health care services to be provided.”  However, in emergency situations, the out-of-network provider would have to accept payment at the median amount within the region that a health insurer pays an in-network provider, or accept 150 percent of what Medicare pays for a medical service, whichever is greater.

Patients would still have to pay their customary copays or deductibles built into the health insurance coverage.

Chamber Position

SUPPORT:   

Employers are often on the front lines of having to help their employees understand their insurance bills and why they may have received a bill for $100, $500 or several thousands of dollars from an out-of-network health care provider practicing at an in-network facility. The employer is often the one explaining why, even though the patient was never told the network status of the provider or given an estimated cost for procedure, he or she must pay this surprise medical bill.

Ideally, the free market would settle these problems. But if healthcare and health insurance were a free market, prices for health care goods and services would be set freely between patients and health care providers. That is not the reality of our system today. The price of these services is not negotiated by the patient and thus patients are being blind-sided by these billing practices. In emergency situations, good questions cannot be asked about other options and out-of-pocket costs associated with the procedure. Even in non-emergency situations, patients lack the necessary tools to explore their options. This package of bills works to address these problems and find a solution.

Bill Sponsors

This bill is a

Primary Sponsor: Rep. Roger Hauck, District 99

Additional Supporter
Angela Witwer, District 71 Frank Liberati, District 13 Matt Koleszar, District 20 Douglas Wozniak, District 36

Primary Sponsor: Rep. Frank Liberati, District 13

Additional Supporter
Matt Koleszar, District 20 Douglas Wozniak, District 36 Roger Hauck, District 99

Related Issues

Support
Legislation to End Surprise Medical Billing

This legislation would lessen the impact of surprise medical billing.  Surprise billing occurs when a patient receives care from a physician who does not contract with their health insurer and is considered an out-of-network provider. The situation can leave patients with large medical bills when they receive care, often unknowingly, from a provider who is not part of their health insurer’s established network.

The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. The notice must inform the patient that a non-participating provider must provide them “a good-faith estimate of the cost of the health care services to be provided.”  However, in emergency situations, the out-of-network provider would have to accept payment at the median amount within the region that a health insurer pays an in-network provider, or accept 150 percent of what Medicare pays for a medical service, whichever is greater.

Patients would still have to pay their customary copays or deductibles built into the health insurance coverage.