Originally published on February 11, 2019 10:20 am
Lawmakers in Colorado say they're seeing a growing number of cases where patients visit a hospital in their insurance network but unknowingly get treated by an out-of-network specialist or surgeon.
Then the patients get sent a surprise bill, and the worrying starts.
When Zoe Williams took her 3-year-old daughter to the hospital three years ago with a broken femur, the mother didn't know whether the hospital was in her insurance network.
She was focused on getting the quickest and best care possible after her child took a fall in a park.
Williams also trusted her health insurance would cover it.
"The entire time we kept thinking thank goodness we have health insurance, because we don't have to make hard choices other people might have to make in that moment," Williams said Thursday.
Two years later, Williams said she was surprised to get bills totaling several thousand dollars from the hospital visit.
It was then she learned the hospital was out-of-network.
Williams said it took over six months to fight the charges successfully.
She's hoping other parents and patients don't have to go through the same ordeal.
"Had we not been willing to fight, our entire financial stability would have been destroyed," she said at a press conference on Thursday where lawmakers announced new legislation to tackle the issue.
Two different bipartisan bills at the State Capitol are trying to address the issue of surprise medical costs.
Both would prevent patients from getting billed if they didn't have a way of knowing a health care provider was out-of-network in an emergency situation.
But they would only apply to state-regulated insurance plans.
The first bill is sponsored by State Rep. Daneya Esgar and Rep. Marc Catlin.
It would set a cap on the amount a provider could charge an insurance company for out-of-network care.
"This bill holds the consumer harmless in these types of situations," Esgar said. "It has several benchmarks laid out in the bill to really help make sure that these kinds of exorbitant charges don't happen in the first place."
State Sen. Jack Tate and Sen. Rhonda Fields are pitching their own bipartisan bill to tackle the surprise billing issue.
The two bills differ in how they seek to set the cap on the amount a health care provider can charge an insurance company for out-of-network care.
Adam Fox, of the Colorado Health Initiative, said he thinks the House version of the bill will keep the cost of out-of-network care lower than the Senate version.
But Tate suggested his bill might get more support from health care providers.
He said if lawmakers set the limit for out-of-network costs too low, it could hurt the health care providers.
"While we're trying to make sure we're protecting consumers, we want to also make sure whatever we do here at the capitol strikes a fair balance between providers and insurance companies," Tate said. "When that relationship between providers and insurance companies gets out of balance, then we have an access problem for consumers getting to good providers."
Both bills will be debated in the coming weeks at separate hearings.
Capitol Coverage is a collaborative public policy reporting project, providing news and analysis to communities across Colorado for more than a decade. Eleven public radio stations participate in Capitol Coverage from throughout Colorado.
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