Tag: balance billing

Five Years in the Making: Consumer Advocates’ Role in Passing Comprehensive Surprise Billing Legislation

Quote from consumer about surprise billing and summary of blog

Today, Governor Kemp signed the Surprise Billing Consumer Protection Act into law! Georgians for a Healthy Future and our partners at Georgia Watch strongly supported this bipartisan bill to protect consumers from surprise out-of-network medical bills.

These exorbitant bills often burden patients with high amounts of medical debt. In fact, over half of debt collection actions contain medical debts, leading to bankruptcy for many consumers. Take George C. of Lilburn, for instance, who had his right foot amputated at an in-network hospital. Even after obtaining assurances from his insurer that the provider was in network, he still found himself stuck with costly medical bills. “I found out they used out-of-network providers when they assured me they would [not]. They would not dismiss the bills and I had no alternative but to file for bankruptcy,” said George, after receiving surprise medical bills totaling $60,000.

With the signing of the Surprise Billing Consumer Protection Act, the state has taken an important step toward protecting consumers from the nightmare scenario George experienced. Georgia is the 16th state to have adopted comprehensive protections against surprise medical bills, covering an estimated 2.5 million Georgia residents when the law goes into effect in 2021.

As a bonus, the legislation also allows Georgia to establish an all payer claims database (APCD), which is a powerful tool used by 19 other states. Georgia’s APCD will inform the surprise billing payment resolution process, but will also be used to help policymakers, stakeholders, and advocates develop better understandings of health care costs, use of services, population health trends, and disparities.

Thank you to all who followed the surprise billing debate and helped bring it across the finish line by contacting your legislators at each stage of the process!

This win was a long time in the making, and a very committed group of state leaders worked tirelessly on surprise medical bill protections for many years. That includes the bill sponsors, Sen. Chuck Hufstetler and Rep. Lee Hawkins, Chairman Richard Smith,  and the Governor and Lieutenant Governor and their staffs. Georgia Watch and Georgians for a Healthy Future (GHF) were fortunate to play meaningful roles as well.


The beginning of the debate

The Georgia General Assembly’s consideration of surprise billing protections stretches back to 2015 when legislators began to look at the inter-related issues of network adequacy and surprise out-of-network medical billing (called surprise billing or balance billing). Following the 2015 legislative session, the Georgia Senate convened the Consumer and Provider Protection Act study committee to look at these issues and to which GHF’s then Executive Director was appointed.

Picture of a speaker at a podium

To buttress the work of the committee and highlight the importance of addressing both surprise billing and network adequacy for consumers, Georgia Watch and GHF held the Getting What You Pay For policy forum in February 2016. As a result of the study committee’s work, the policy forum, and powerful advocacy by Georgia Watch and GHF, the 2016 legislative session saw the successful passage of SB 302, which required health insurers to maintain accurate lists (called “provider directories”) of in-network medical providers.

While the state legislature did not have the appetite to take on surprise billing in all of its complexities in 2016, Georgia Watch and GHF knew this important consumer issue had the attention of policymakers.


Stalemate

We did not want to lose the momentum for surprise billing protections. Using the time between the 2016 legislative session and the start of the 2017 session, Georgia Watch and GHF worked closely with legislative leaders to inform their thinking on the issue and to craft legislation. Unfortunately, the legislative options put forward by state leaders in the 2017 session failed because of disagreements between insurers and providers about how to resolve payment disputes.

Dedicated leadership by legislators and continued partnership with consumer advocates could not overcome the entrenched disagreements between doctors and hospitals, and health insurance companies over the costs of care. This dynamic continued through the 2018 and 2019 legislative sessions, leaving consumers vulnerable to expensive, unfair medical bills through no fault of their own.


“If you want to go fast, go alone. If you want to go far, go together.”

Recognizing the on-going stalemate, Georgia Watch and GHF thought carefully about how to overcome this impasse. After studying surprise billing successes in other states, we agreed that success would require a united front from legislative leaders with a Georgia-specific solution.

Georgia Watch and GHF approached Sen. Hufstetler, Chairman Smith, and Rep. Hawkins about pursuing a “united front” strategy in the summer of 2019, and as a result of the trusting relationships we had built with them over many years, they agreed to participate and guide the process. Through GHF’s relationships at Georgetown University’s Center on Health Insurance Reform, we were able to bring in national experts on surprise billing who shared the latest information on state and federal proposals and discussed how other states tackled major issues, both of which helped bring a few fresh ideas to the table. Sen. Hufstetler and Reps. Smith and Hawkins—as eager as we were to break the stalemate—used that information and input from Georgian Watch and Georgians for a Healthy Future to develop a solution that works for Georgia but that was informed by efforts in other states.

This bi-cameral strategy attracted the support of Gov. Kemp and Lt. Gov. Duncan, both of whom had already expressed interest in passing surprise billing protections. When HB 888 and SB 359 were introduced in January, state leaders showed courage and commitment by sticking with the approach they had collectively developed, even over the objections of some stakeholders.

As the bill moved through the General Assembly, more state legislators, hospitals, and provider groups lent their support to the legislation. Moving this bill across the finish line involved negotiation among multiple parties, support from our partners in the patient and consumer advocacy community, storytelling from consumers who had experienced surprise bills, and a reliance on the trusted relationships that Georgia Watch and GHF had with state leaders.

Our efforts now move to the Georgia Department of Insurance (DOI) and the Office of Health Strategy & Coordination (OHSC). DOI will write the rules that guide the implementation of surprise billing protections which will take effect on January 1, 2021. The OHSC will develop funding for and lead the creation of Georgia’s all payer claims database.


It is rare for a state to go from no protections to comprehensive protections in one fell swoop, especially with the near unanimous support we saw in the Georgia General Assembly. Georgia Watch and GHF believe that this success demonstrates the incredible impact of long-term, sustained consumer advocacy at the Georgia Capitol and in other spaces where decisions are made. This kind of advocacy takes staff time, focus, expertise, and resources, all of which are provided by individual donors and philanthropic funders like you.

Our organizations work for you but we cannot do our work without you! Please support our consumer advocacy efforts with a donation today. Thank you!

Consider a donation to our partners at Georgia Watch too!


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Legislative Update: Transportation and movement on surprise billing

Legislative Update: Week 5

Legislative session resumes this week

After a brief pause last week due to budget disagreements the Georgia legislature will resume its normal schedule today, February 18th. Today is day 13 (out of 40) of this year’s legislative session. According to the legislature’s new calendar, Crossover Day (the day by which a bill has to be approved by at least one chamber in order to remain “alive” for this year) is scheduled for March 12th.


Surprise billing legislation set for committee vote

Senate and House action expected on surprise billing legislation this week

Last month, companion pieces of legislation were introduced in the House and Senate to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. SB 359 and HB 888, sponsored by Senator Hufstetler and Representative Hawkins respectively, both contain strong consumer protections and set a resolution process that allows insurers and health care providers to settle payment disputes while keeping consumers out of the middle.
 

The Senate Health and Human Services committee heard testimony from insurers, advocates, and medical providers at a hearing on SB 359 last Tuesday. GHF’s Executive Director testified on the bill saying, “the consumer protections in this bill are fair and reasonable. For these reasons, we support (SB 359) and hope to see its successful passage by both chambers during this session.”

HB 888 is scheduled to be heard in the House Special Committee on Access to Quality Health Care today at 2pm.

Call one or more of these committee leaders to ask for their support of SB 359 and HB 888: 

  • Sen. Ben Watson, Chairman of Senate HHS committee,
    404-656-7880
  • Sen. Dean Burke, Vice Chairman of Senate HHS committee, 404-656-0040
  • Rep. Mark Newton, Chairman of the House Special Committee, 404-656-0254
  • Rep. Sharon Cooper, Vice Chairman of the House Special Committee, 404-656-5069

If your state Senator or Representative is on either committee, please call them as well!


Prescription drug legislation heard by senate committee

SB 313: Pharmacy benefit managers, the middlemen for prescription drugs

SB 313, sponsored by Senator Dean Burke, had its second hearing in the Senate Insurance and Labor committee last Wednesday. This bill would update Georgia’s oversight of pharmacy benefit managers and add important consumer protections. Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits for health insurance companies and in that role are charged with negotiating lower costs for the company and consumers.

At Wednesday’s hearing, patients, doctors, pharmacists and representatives of pharmacy benefit managers offered detailed testimony on the bill. No further action was taken on the bill last week and it is unclear if the Senate Insurance committee will consider it again this week. GHF will continue to report on the bill through the legislative session. (We provided an overview of the bill in an earlier legislative update.)


Rural transit bill could bring changes to Medicaid transportation

Revisions to transit bill attract support from more stakeholders

Adequate transportation is important to the health of Georgians because in most cases people need to go to a location outside of their homes to receive health care. Without access to reliable, safe transportation, Georgians may be forced to skip health appointments and go without medication, or they may not be able to access other things (like healthy foods or good schools and jobs) that would help them stay healthy.

HB 511, sponsored by Representative Kevin Tanner, would create a new division within the Georgia Department of Transportation (GDOT) that would, among other things, oversee rural transit programs including Medicaid’s non-emergency medical transportation (NEMT) services. The bill would divide the state (except for 13 metro-Atlanta counties) into eight regions in which counties could collaborate to raise revenue for and coordinate rural transit services. The purpose of the proposed “mobility zones” is to eliminate restrictions on crossing county lines for health appointments and other services for seniors, low-income families, and other needy Georgians, and extend transportation services to those who do not have access to local transportation options.

Advocates for Georgia seniors supported earlier versions of the bill and recent revisions to the bill have earned the support of GDOT and Uber. HB 511 has not been scheduled for a hearing but GHF will report on the legislation as the session progresses.


GHF has you covered

Stay up-to-date with the legislative session
 

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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