ZACHARY: Create medical bill transparency

Published 7:00 am Tuesday, February 18, 2020

Once again Georgia lawmakers have a chance to serve the public by creating more transparency.

This time, rather than passing measures to create greater access to government, legislators have the unique opportunity to impact the lives of ordinary people who get saddled with extraordinary medical bills, sometimes pushing them to the bring of bankruptcy and beyond.

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Rep. Mark Newton, R-Augusta, chairman of the the House Special Committee on Access to Quality Health Care, has drafted the Surprise Bill Transparency Act.

Newton wants to require insurance agencies to post online which hospitals in their network have specialty services performed by doctors who are also in their network for the four most common specialties: anesthesiologists, pathologists, radiologists and emergency medicine physicians.

The measure does not go far enough, but it is most certainly a good first step toward more transparency in actual medical costs.

So there may be some concern, as ones raised by some community hospitals about a rating system for hospitals and insurance providers that is baked into the transparency initiative, but the benefits of greater transparency should far outweigh any concerns by the hospitals and insurance companies. 

Essentially, the rub seems to be a rating system that uses four green check marks for specialties provided by a hospital and covered by in-network insurance providers or red X marks for services not covered.

Consumers are smart enough to navigate a system that includes accurate information.

The challenges around making sound medical and financial decisions have been exacerbated by an opaque system that makes it almost impossible for the average consumer to know exactly what is and is not covered and at what level those services are covered.

Rep. Spencer Frye, D-Athens, made a good point when he said he was going to vote against the measure. “I will be voting against it only because I don’t think that it does enough,” he said. “If we’re going to start tackling these issues that we really need to focus on reining in these out-of-control insurance companies.”

Even though he is right about out-of-control insurance costs, he is wrong to not at least take this first step toward greater transparency.

No one, most especially no one struggling with serious medical issues and financial ruin, should have sticker shock when the medical bills start pouring in.

Surprise billing was identified as one of the Senate Majority’s 2020 priorities. The Surprise Billing Consumer Protection Act would establish consumer protections against surprise bills from medical services.

Sen. Ben Watson, chair of the Health and Human Services Committee, wants to hold insurance companies as well as hospitals accountable for billing patients inaccurately. His measure requires a set price list of what government-regulated insurance companies have predetermined in their contracts for emergency and non-emergency services. The state Department of Insurance would be required to create a health claims database.

Watson doesn’t want patients receiving bills for doctors and staff who are independent contractors of a hospital, but not covered by the patient’s insurance. Preventing those kinds of surprise bills, which are common, would be a great relief for Georgia consumers.

Andy Miller, CEO and editor of Georgia Health News, reported that the “Georgia Right to Shop Act’’ would allow patients to query their insurance company, either online or on the phone, on what out-of-pocket costs they would face if they use a particular medical provider.

Doesn’t all of this just make sense?

Shouldn’t a consumer, in this case a patient or their family members, be able to know upfront exactly what their costs will be so they can make informed decisions?

Maybe Georgia lawmakers cannot fix a very broken health care and health insurance system, but they can do this. They can provide the public with greater transparency and fewer astronomical surprise medical bills.

CNHI Deputy National Editor Jim Zachary is the editor of the Valdosta Daily Times and president of the Georgia First Amendment Foundation.