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NCOIL Panel to Tackle Balance Billing

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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 USAfor 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,

but the facility or provider would have to warn an insured patient that the care was being provided out-of-network and that the patient might have to pay the charges that the patient’s health insurer did not cover.

When the facility billed the patient, the facility would have to offer the patient help with understanding the bill.

Primary care doctors and ordinary specialists may balance bill patients, but the issues tends to come up frequently in hospitals. Patients may go to in-network hospitals and arrange for care by in-network providers, such as surgeons, and then find that other providers, such as radiologists and anesthesiologists, provided care out of network.

The health committee also will consider a proposed model, the Healthcare Sharing Ministries Freedom to Share Act, that would exempt religious health care-sharing ministries from state insurance laws.