Senate OKs Archambault bill that seeks to limit ‘surprise billing’ for out-of-network health care services
STATE HOUSE — The Senate today passed legislation introduced by Sen. Stephen R. Archambault (D-Dist. 22, Smithfield, North Providence, Johnston) that would change the way out-of-network health care professionals are paid after rendering services to patients who didn’t have the opportunity to select such health care services from in-network professionals.
“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, 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 (2018-S 2077Aaa) would provide a method for the reimbursement to out-of-network professionals who provide unanticipated care and would provide guidelines for what payment those professionals may seek or accept from a patient for unanticipated out-of-network care.
“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 aims to make surprise billing a rare event, by clearly defining unanticipated and anticipated out-of-network care and by allowing patients to get written cost estimates before undergoing surgery or non-emergency, facility-based procedures. The bill further says that no health insurance carrier may require prior authorization for rendering emergency services to an insured patient. The legislation also prevents balance billing, which is when patients are billed for the amount in excess of what a doctor might get paid in a negotiated settlement. Under the provisions of this legislation, no health insurance carrier would be able to impose a coinsurance, copayment, deductible or other out-of-pocket expense that is greater than those that would be imposed if such services were rendered by an in-network health care provider.
The bill also contains a provision for the nonprofit American Arbitration Association to resolve disputes between the out-of-network provider and the insurance carrier through binding arbitration, and it prevents the health care professional from billing a patient while the claim is being negotiated or arbitrated.
The measure now moves to the House of Representatives for consideration.
For more information, contact:
Daniel Trafford, Publicist
State House Room 20
Providence, RI 02903