Sparrow Hospital, Lansing | Susan J. Demas
A state House committee Thursday morning heard testimony from two state representatives with a bipartisan plan to protect Michigan patients from what they call “surprise medical billing.” Various state physicians’ associations, however, were not pleased and spoke out vigorously against the bill package.
House Bills 4459 and 4460, introduced by state Reps. Roger Hauck (R-Mt. Pleasant) and Frank Liberati (D-Allen Park), respectively, would regulate charges from non-participating (or “out-of-network”) health care providers. The legislation aims to prevent the burden of unexpected medical costs by “taking the patient out of the middle, and giving them the tools they need to make an informed decision about their health care,” Hauck said.
“When a patient pays their [health insurance] premiums, co-payments and their deductibles … and do their due diligence to make sure they are seeking treatment at an in-network medical facility, they should not have to worry about opening their mailbox to find a surprise medical bill,” Liberati said.
Hauck’s bill, HB 4459, focuses on protecting patients in emergency situations.
If an insured person didn’t have the chance to choose an in-network provider for a medical service, or if the only provider available to perform that service was out-of-network, that non-participating provider would have to accept 125% of Medicare (or the average in-network amount; whichever is higher) as payment in full.
Providers also would be prohibited from attempting to collect any more money, unless the patient owed fees for coinsurance, co-payment or deductibles — or else face an administrative fine.
Hauck shared an anecdote about a constituent who seemingly did everything right. The man had knee surgery scheduled at an outpatient facility and called ahead to make sure that the facility was in-network. It was. He still, however, ended up receiving a large, unexpected medical bill after the surgery because one of the doctors who assisted in his procedure that day happened to be out-of-network.
“I cannot think of any [other] industry where this practice could be acceptable,” Hauck said.
Liberati’s bill, HB 4460, aims to protect patients seeking non-emergency medical care. When there’s advance notice given to an out-of-network provider, that entity could only bill the patient for what their health insurance doesn’t cover if the patient consents in writing at least 14 days prior to the procedure, or during the pre-surgical consultation – whichever is earlier.
Within that written disclosure, the out-of-network provider would be required to give a good-faith estimate of the cost. They also would need to advise the patient of their right to arrange for services to be provided at a lower cost by an in-network provider.
“This legislation establishes some of the strongest state-level patient protections against surprise bills, and empowers patients to make informed decisions about their health care,” Liberati said.
Representatives from numerous state associations also testified. The Michigan Association of Health Underwriters (MAHU) supports the bills and the state Department of Insurance and Financial Services (DIFS) took a neutral stance.
But the comments from physician organization were largely critical of the two bills.
Michigan State Medical Society (MSMS) lobbyist Christin Nohner told the committee that although MSMS agrees that surprise medical billing is a problem in the state, the group doesn’t believe the proposed legislation is the right solution.
Dr. Thomas J. Veverka is a trauma surgeon who sits on the MSMS board of directors. He spoke out strongly against both bills but focused on Hauck’s bill in particular, referring to HB 4459 as the “more problematic” of the two.
Veverka argued that the legislation fails to address “the multitude of factors that can lead to surprise billing,” and could lead to unintended consequences like changes in physician reimbursement.
Representatives from the Michigan Society of Anesthesiologists and the Michigan Society of Pathologists also spoke out against the bills, citing similar concerns.
Neurological surgeon Dr. Christopher Abood practices at multiple hospitals in the Lansing area, including Sparrow Hospital, which Abood says is the second busiest level one trauma center in Michigan.
He offered a recent story to demonstrate how the legislation might affect his practice: the small plane from Indianapolis that crash-landed near Lansing’s Capital Region International Airport earlier this month, killing five of the six people on board.
“Two weeks ago this morning at exactly this time, a very sad incident occurred,” Abood said.
He said that three of the victims were killed on impact, and the other three were brought to Sparrow Hospital in critical condition around 8 a.m.
“Our practice basically dropped everything to go and assist in the care of these patients,” Abood said.
One victim was immediately admitted into surgery for a decompressive craniectomy, a procedure that takes pressure off the brain, Abood said. The second patient went into surgery that afternoon, and the third followed suit the next day. Combined, the team spent two entire days on the three crash victims.
“This bill directly addresses what we should charge and get paid for these surgeries,” Abood said, emphasizing that Medicare-based practices are not compensated well enough to sustain more than a few surgeons at a time due to high overhead expenses.
“We are able to provide Medicare and Medicaid surgery because we are able to offset that with commercial insurance,” he said.
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