Legislature passes ban on surprise bills by out-of-network doctors
SALEM — A bill to ban so-called "balance billing" by health care providers is on its way to Gov. Kate Brown's desk, after the House of Representatives on Tuesday approved Senate changes to the legislation 47 to 10.
Balance billing refers to when a patient seeks care at a hospital or clinic that may be in network under their insurance plan but the individual provider who cares for the patient does not participate in the network. Months later, the patient receives a bill typically significantly larger than what they were expecting.
The passage of the bill is a victory for consumers, said Jesse Ellis O'Brien of the Oregon State Public Interest Research Group.
The legislation is "an urgently needed measure to protect Oregon consumers from large surprise medical bills," O'Brien wrote in a statement Tuesday.
The ban takes effect March 1, 2018, and still needs rules by the Oregon Department of Consumer and Business Services and legislation during state lawmakers' February short session to be enforced. A work group will develop an out-of-network provider reimbursement framework between now and the end of the year, said Patrick Allen, DCBS director.
The bill was amended in the Senate to reflect a compromise between health care providers and consumer advocates. Allen noted last month that the deal is "a little bit of kicking the can down the road, but it also gets the ban on balanced billing locked in place."
Consumer advocates said they are concerned that the reimbursement framework was excluded from the bill.
"If the reimbursement rate is too high, it will raise costs for consumers; if it's too low, it could cause access problems. I think there is a reasonable range in the middle, but it will be important to get it right," O'Brien said.
Balance billing often occurs when patients are unaware that a provider is out of network.
During hearings on the bill last month, Stayton resident Steve Poisson told lawmakers that a couple of years ago, he visited a walk-in clinic for a suspected case of the flu.
"After being examined and having some tests run, I was immediately admitted to the ICU with a diagnosis of heart failure," he wrote in testimony. "It wasn't until several months after my discharge that I received a bill from the hospitalist physician because he was not an 'approved provider' under my plan, which covered all other services rendered while in the hospital."
Poisson said the practice of balanced billing should be banned "because in a situation such as mine there was no way for me to know the 'approved' status of the provider nor make any choice as to who my provider was."
Once the ban takes effect March 1, O'Brien noted that people such as Poisson will only receive a bill for the in-network rate.
"What remains unresolved is exactly how his insurance company and the provider will work it out on the back end," O'Brien said.