Arizona Senator Debbie Lesko approved cost relief legislation, Senate Bill 1441, designed to help residents pay their medical bills.
Arizona Senator Debbie Lesko approved cost relief legislation, Senate Bill 1441, on Wednesday, which is designed to help Arizona residents pay their medical bills whenever someone goes to the hospital and realizes down the road that the expenses haven’t been covered as promised.
One of the most common occurrences under which this would happen is that the individual has checked with his or her doctor and with the hospital directly, ensuring a scheduled procedure is covered, but later receives an out of network bill anyway because the institution has contracted with a third party medical provider to assist with the procedure. For instance, someone who is scheduled for ear tubes would ensure that he or she is covered by their ear, nose and throat doctor and the center performing the surgery. However, that center has, unbeknownst to the patient, contracted with a third party anesthesiologist. The individual will still receive a bill for the this independent provider.
The new legislation will set up checks and balances for the bill recipient, in which the patient can ask the Department of Insurance to get involved and determine an amount the person should be held liable for. The Department would not be able to get involved in all instances, but this would apply in situations in which patients would have had no way of determining that a third party would be used, and therefore, no way of checking to see if this person would be covered by the insured’s plan. The safety net is available if the health care provider also had not told the patient up front this individual wouldn’t be covered by the plan and had not provided an estimated total cost to be billed, or given the patient a chance to waive the right to dispute out-of-pocket charges.
If a patient believes he or she is eligible for the protection offered, a call can be made to the Department of Insurance after the bill’s receipt. The agency will then reach out to the doctor and the insurance company, in most cases resolving the issue. Lesko says this is currently the case in states with similar laws. “In Texas, 94 percent of all the complaints are settled over the phone,” she said. “They settle on the amount and it’s over.”
The insurance company and the doctor split the costs of cases that go to private arbitration, so they have an incentive to settle before a case is dragged out to that point. Plus, if either side disagrees with a case that is settled privately, there is an option to appeal, further elongating the time in court.
If the patient agrees to the out-of-network cost up front and signs off on this, then he or she will be unable to pursue protection under SB 1441. However, if the bill ends up being more than the amount the patient signed off on, the patient could still be entitled to the difference and the process of seeking restitution would still apply.
Lesko acknowledges that advocates for patients’ rights could argue that someone who seeks treatment should never have to pay for anything out-of-network that was not approved ahead of time, but such legislation would never pass due to opposition from doctors.