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3/8/2017 Sen. Archambault legislation would curb surprise medical billing by providing a dispute resolution process
STATE HOUSE — Taking aim at the epidemic of surprise medical bills, Sen. Stephen R. Archambault (D-Dist. 22, Smithfield, North Providence, Johnston) has introduced legislation that seeks to curb the practice.

The bill, which Senator Archambault initiated and wrote last year, passed the Senate during the 2016 session, but never made it through the House of Representatives.

“Surprise medical billing happens when a patient goes to a hospital or emergency room that a health insurer considers ‘in-network’ only to find out later that doctors aren’t necessarily hospital employees and aren’t covered by the same insurance,” explained Senator Archambault. “Oftentimes, 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.

The legislation (2017-S 0494) would provide for a dispute resolution process for emergency services and surprise bills for medical services performed by nonparticipating (out-of-network) health care providers.

“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 their care — even in an in-network medical institution,” said Senator Archambault. “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.”

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.

The legislation, which is cosponsored by Senators Adam J. Satchell (D-Dist. 9, West Warwick), James C. Sheehan (D-Dist. 36, North Kingstown, Narragansett), Donna M. Nesselbush (D-Dist. 15, Pawtucket, North Providence) and V. Susan Sosnowski (D-Dist. 37, South Kingstown, New Shoreham), has been referred to the Senate Health and Human Services Committee.

For more information, contact:
Daniel Trafford, Publicist
State House Room 20
Providence, RI 02903