July 22, 2015

Controlling Surprise Health Care Bills

Kaiser Health News recently reported on New York’s efforts to help consumers minimize the financial impact of “surprise” health care bills. Under a law that took effect April 1, 2015, patients are prevented from owing more than their in-network copayment, coinsurance, or deductible on surprise bills for out-of-network emergency services. A bill is generally considered a surprise if consumers receive services without their knowledge from an out-of-network doctor at an in-network hospital, among other things. A surprise bill also results when a patient is referred to an out-of-network provider but has not signed a written consent form agreeing that the services will be out of network and may result in higher out-of-pocket costs.

Connecticut legislators recently enacted surprise billing legislation, which takes effect July 1, 2016. Under PA 15-146 (§§ 9 & 10), if an insured patient receives a surprise bill, he or she will only be required to pay the coinsurance, copayment, deductible, or other out-of-pocket expense that would apply if the services had been rendered by an in-network provider. Under the act, a surprise bill is a bill for non-emergency health care services received by an insured for services rendered by an out-of-network provider at an in-network facility during a service that was performed by an in-network provider or previously approved by the health carrier, and the insured did not knowingly elect to receive the services from the out-of-network provider. The act also prohibits health insurers from charging an amount for emergency services performed by an out-of-network provider that is greater than that charged when performed by an in-network provider.