PHOENIX — The Arizona House approved amended legislation Wednesday designed to give more protection to patients who receive unanticipated medical bills from out-of-network providers, as legislators across the U.S. continue to fight the issue known as “surprise billing.”
Though most patients make sure care from doctors and medical facilities are part of their insurance networks, health care consumers all over the country are repeatedly being hit with surprise medical bills.
Patients typically incur the unexpected fees because of hospitals’ contract out-of-network providers who work as specialists.
House lawmakers heatedly debated the amended bill, with legislators on both sides of aisle calling on the chamber to oppose the measure, before passing it on a 40-19 vote. The Senate already approved the bill on a 25-5 vote in March.
“This is gonna to have a chilling effect on doctors going to those rural communities and providing care because they are not able to set their own fees,” Rep. Maria Syms said during the floor debate.
“The fees ultimately will be set by the insurance companies — an out-of-network doctor or health care provider is the worst nightmare of an insurance company.”
Lesko has said the bill, Senate Bill 1441, would help solve a state issue that patients have no control over.
“They have no avenue now,” Lesko said. “Now they gotta call the doctors and then the doctors refer them to the insurance companies and they go back and forth — they have no place to go now.”
The legislation would allow consumers to ask the Arizona Department of Insurance to assign an arbitrator to settle the dispute if they receive a bill of $1,000 or more from out-of-network providers.
But it would require patients, insurers and providers to first try to settle the dispute in an informal phone call before advancing to arbitration. Both providers and insurers would split the costs of the arbitration.
The bill would also require patients to agree in writing to pay doctors their deductibles and co-pays before arbitration. Lesko said that clause helped doctors become neutral on the bill because it assured them they would get paid the undisputed portions of the medical bills.
Other states have taken harder stances on the issue, with some lawmakers proposing measures that curb surprise billing by banning it.
Rep. Pamela Powers Hannley said other states’ legislation models tackling surprise billing are less complicated and address systemic issues surrounding the out-of-network bills such hospitals’ scheduling procedures.
Stephen Briggs, an Insurance Department spokesman, has said the agency does not track complaints about surprise billing in the state.
Opponents said the measure would likely not solve the problem and would only add more complexity to the already over-regulated health care industry in place. They also criticize it as threatening the free market system.
“The outcomes of this bill is going to be a long term detriment to where our physicians are gonna be going and how they’re gonna to be treating our patients,” Rep. Regina Cobb said.
“We are allowing the insurance companies right now to dictate to us, to dictate how our care is going to be done.” Cobb is a dentist.
The House’s approval of the bill sends it back to the Senate for final approval before it heads to Gov. Doug Ducey’s desk.
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