Bill: Hospitals inform patients about out-of-network services

The House Insurance Committee Tuesday amended and recommended to the full chamber a bill that would require hospitals to disclose which medical providers are not in a patient’s insurance network prior to scheduled non-emergency services.
House Bill 435 by Kirk Talbot, R-River Ridge, proposes that hospitals provide the patients with a list of the medical providers associated with the hospitals. Currently, health care facilities provide a list of out-of-network physicians only upon request.
Out-of-network doctors can charge a patient what they wish and the insurance company typically pays only 70 percent of its regular contracted rate with in-network providers.
Under the bill, health care facilities would also notify patients about their right to request information regarding their insurance network eligibility in relation to these physicians, as well as the possibility of being charged for out-of-network health services.
Talbot said currently health care facilities provide patients a notice mentioning the possibility of extra charges, but it is “buried” among other documents the patient receives. He said patients typically have not been aware of this notification.
The bill would make the notice a separate page that would require a patient’s signature. The enrollee would sign a copy of the notice and the hospital would retain the document.
Talbot said that patients assume everything is covered after surgery, but then they get a bill a few weeks or months later saying one or more medical providers was not in their network, resulting in a balance of thousands of dollars.
If healthcare facilities failed to provide the required notice to a patient, the bill would require the facility to pay the out-of-network providers’ fees not covered by the patient’s health insurance, including but not limited to the insured’s contractual deductible, coinsurance, or co-payment amount.
“I do think it’s a step in the right direction,” Talbot said, but that lawmakers still need to address the emergency room billing issue.