Legal Protection from Balance Billing
Surprise Billing. Balance Billing. Out-of-Network Russian Roulette. Anyone who has experienced an out-of-network claim knows the sky has been the limit for non-contracted providers, and these types of horror stories contributed to state and national movements to pass laws bringing consumer bills under control. Here’s what your local and national lawmakers are doing to protect you and your employees.
Oregon Surprise Billing Legislation
Effective March 1, 2018, the new law protects members who have unknowingly sought care from out-of-network providers. Providers must inform consumers about increased financial responsibility related to network status and, unless given prior consent, the out-of-network provider cannot balance bill the member. The reimbursement to the provider will be based on the median commercial insurance payment in the APAC database. Those who wish to lodge a complaint may call 888-877-4894 or file online.
Washington Proposed Legislation
A bill to prevent balance billing currently in the Washington state legislature prevents members from receiving a surprise medical bill when they seek medical services from an in-network facility that may employ out-of-network providers. 2SHB1062/SB 5031 passed the House of Representatives and is currently in front of the Senate Health and Long Term Care Committee.
The Washington Office of the Insurance Commissioner is requesting members who have experienced a surprise bill to email them stories.
California Surprise Medical Billing Legislation
Effective July 1, 2017, the California law requires that members who visit an in-network facility are responsible for the in-network cost share, even if seen by an out-of-network provider. The legislation affects fully-insured plans purchased in the state of California and any others overseen by the Department of Managed Health Care (DMHC) and does not change self-insured employer responsibilities.
The National Association of Health Underwriters (NAHU) joined coalition partners challenging congressional leadership to support legislation currently being drafted that curbs surprise medical bills to patients in emergency or involuntary care scenarios when patients had no choice in specific provider or, sometimes, even site of care. NAHU is encouraging Congress to consider requiring providers to inform patients of network status and their options for seeking care and set reimbursement rates that are reasonable based on geographic area and overhead costs.
The House Committee on Education and Labor recently heard from patient and provider advocacy groups on the subject.
What if a member still receives a surprise bill?
Aldrich Benefits clients are supplied with a Member Advocate who works directly with providers to educate them on what the law allows them to charge, and what they cannot! Recently, Providers have begun to write-off balance billing charges for multiple members as they were not submitted in alignment with the law. If you have an employee who has been subjected to a large balance bill, let your Aldrich team know and we may be able to help. It can mean a huge savings to your employees at no additional cost to the plan.
Meet the Author
Aldrich Benefits LP
Mandi has over a decade of experience in the employee benefits world. Prior to joining Aldrich, Mandi served as an account manager at a brokerage firm in Portland, Oregon, specializing in health and life insurance for groups ranging from 100-4,000 employees. Her experience also includes providing benefit calculations for retirement plans at a large actuarial…
- Self-funding and complex contracting
- Consumer-driven healthcare plans
- Plan compliance
- Financial Analysis