A committee at the National Conference of Insurance Legislators (NCOIL) wants to keep surprise medical bills from kicking patients who try to use in-network providers in the head.
The Health, Long-Term Care & Health Retirement Issues Committee plans to consider a proposed Healthcare Balance Billing Disclosure Model Act during the NCOIL spring meeting, which is set to start March 4 in Washington.
NCOIL approved a dental balance billing model in November 2010.
The new draft model, co-sponsored by Vermont state Sen. Ann Cummings, D-Montpelier, Vt., and Louisiana state Rep. Charles Kleckley, R-Lake Charles, La., would help set billing rules for hospitals, clinics and facility-based providers who treat patients out of network on a non-emergency basis.
The draft model defines “balance billing” as a case of an out-of-network provider “charging the enrollee the difference between the provider’s fee and the sum of what the enrollee’s health benefit plan pays and what the enrollee is required to pay in applicable deductibles, co-payments, coinsurance or other cost-sharing amounts as required by the health benefit plan.”
If the model were enacted and implemented by a state as written, an out-of-network facility or facility-based provider could still bill a patient for the full, retail price of care,