A new Georgia bill aims to promote transparency in medical billing for outpatient procedures, according to Georgia Health News.
Here are five things you need to know:
1. Surprise billing occurs when consumers think they are receiving in-network care—either at an in-network hospital or surgery center—but out-of-network providers participate in the case. Patients then would receive separate bills from the out-of-network providers who were involved with treatment.
2. Under House Bill 678, a consumer receiving outpatient services from a hospital, physician practice or treatment facility would, upon request, receive information on whether the providers are in the patient's insurance network, projected costs and what the policy will pay.
3. If the health plan does not have a provider in the geographic area, the bill requires insurers to inform members on obtaining an out-of-network referral. The bill would also require the insurer to disclose the amount reimbursed under out-of-network services.
4. Another provision would require medical bills to be sent to patients within 90 days of discharge or service provision. The person responsible for payment would then have 90 days afterward to pay, negotiate amounts or initiate arbitration; only after that point would the hospital or provider be allowed to formally begin collection efforts.
5. The patient or person responsible for payment could initiate arbitration within the 90-day period by filing an application with the insurance commissioner, who would provide rules and procedures for navigating the arbitration process. The Georgia Hospital Association and the Medical Association of Georgia, a physician organization, have expressed concerns over the proposed arbitration process.
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