Paper Mache Armor

Our Governor, Mike DeWine, is on TV with Dr. Amy Acton, the Director of Health, almost every day.  The Ohio House and Senate are in session and working.  Having our government working for us could be a good thing.  There certainly is no shortage of issues for them to address.

One of those issues is Surprise Billing.  On May 20^th the Ohio House unanimously passed H.B. 388, the legislation specifically designed to address out-of-network care. The legislation was introduced in the Ohio Senate on May 26^th.  It should get passed and be signed by the governor next week.  The Bill is only 14 pages and if you promise to take a quick look I won’t feel compelled to review all of it here. 

The vast majority of H.B. 388 is devoted to the way out-of-network charges are defined and, more importantly, how the providers (doctors, facilities, ground ambulances, and clinical laboratories) will be paid.  There is a definition of the Benchmark or the fair market value for payment.  There is extensive verbiage related to negotiation and, if necessary, baseball style arbitration.  And as was reported in the newspapers, the consumer cannot be billed for the difference between his/her insurance plan’s reimbursement and the providers’ charges.

It looks great, but it is only paper mache armor.

H.B. 388 has the same gaping loophole as some of the other bills introduced in the Ohio legislature.  If you care to read along, turn to Page 6, Line 143 of the bill.  Let me summarize:

• For services covered by the health plan, but are provided by an individual out-of-network provider, an individual cannot be balance billed unless all of the following are met:

a)      The provider informs the individual that the provider is not in the covered person’s health benefit plan.

b)      They provide the consumer with a good faith estimate, including a disclaimer that they are not required to get the services at that location for from the provider.

c)       The covered person consents to the services.

There was no budge on this provision.  A requirement that the disclosure be made 24 or 48 hours prior to the procedure would have been useful.  A requirement that the fees be clearly stated with an explanation of how or why the final price could change with a limit to that change would have been useful.  A prohibition of sticking a form in front of a patient mere minutes before a procedure and “asking” for consent, would have been useful.  My guess is that we will be revisiting this in a year or so once the abuses add up to a point where this has to be taken seriously.  I am sure that the hedge funds that own some of the biggest offenders, the ones whose actions created the need for this whole discussion, will have their consent forms printed before Governor DeWine can affix his signature to the final bill.

Or not.  Those are my concerns.

But our representatives, our senators, and our governor are working to protect us.  I just wish they would take the time to make our armor of stronger stuff.

DAVE

www.cunixinsurance.com

Picture – Ready To Make My Shield – David L Cunix