Health Care

Health price transparency continues to advance

April 7, 2021

Ray Carter

Legislation that incentivizes price transparency and deters “surprise medical bills” has cleared another legislative hurdle, passing out of a state House committee.

Senate Bill 548, by Sen. Julie Daniels and Rep. Tammy Townley, would prevent medical providers from turning a customer bill over to a collection agency if the provider did not first provide a “good faith” estimate of the total bill in advance of treatment.

Townley, R-Ardmore, said the bill is about protecting consumers first and foremost.

“I want to protect my people,” Townley said. “And I want to protect them from those surprise bills (so) that whenever they get those in the mail that they have an advocate, that they have a way of combating that. Because a lot of times, you know, they’re the little guy. They’re the little guy in all this whole scenario.”

The legislation requires the provider estimate to include the “total cost of all healthcare services,” including “all services” performed by a contractor, affiliate, or any other third party, including out-of-network providers.

SB 548 would require medical providers to produce the estimate “separately from all other forms, information, and paperwork” and provide it in “a readable font, plain language” that must be “prominently and conspicuously displayed on the first page of the document in which it is contained.”

In cases involving emergency care when a cost estimate cannot be provided prior to treatment, the legislation would limit the bill to no more than 165 percent of the Medicare rate and no more than “the enrollee’s health benefit plan’s in-network rate for the emergency services rendered.”

However, Townley said she plans to amend the bill to instead require use of “fair market” prices for emergency care.

Should a medical provider fail to produce an advance good-faith estimate of treatment cost, the lack of an estimate would be “grounds for dismissal of any collection suit or garnishment proceeding and may be asserted as an affirmative defense to any such action.”

As a result, Oklahomans’ credit ratings could not be harmed by unpaid “surprise” medical bills, which critics argue are often wildly inflated, particularly for the uninsured.

In 2019 Oklahoma Watch reported that a review of court records since 2016 found that “dozens” of Oklahoma hospitals had “filed at least 22,250 lawsuits against their former patients over unpaid medical bills.”

One member of the committee said the legislation was personally relevant.

“I’ve dealt with this myself,” said Rep. Ty Burns, R-Pawnee, “and ‘surprise billing’ is very frustrating to a lot of us.”

However, one lawmaker questioned if medical providers, particularly those in rural areas, are capable of producing an accurate estimate of treatment cost prior to administering services.

“Aren’t we putting an onus on some of the most stressed components of our healthcare system to guess what it’s going to cost to provide treatment?” asked Rep. John Waldron, D-Tulsa.

“No, I disagree, because most of your rural areas, they pretty well know what their prices are going to be,” Townley said.

While some medical providers have balked at up-front pricing, others have long embraced it, such as the Surgery Center of Oklahoma, which publicly posts the price of numerous procedures on its website.

“The pricing outlined on this website is not a teaser, nor is it a bait-and-switch ploy,” the Surgery Center of Oklahoma’s website states. “It is the actual price you will pay.”

That’s in stark contrast to business-as-usual for many other medical providers. Although a new federal rule requires hospitals to publicly post the previously confidential prices negotiated with insurers, a recent Wall Street Journal investigation found that “hundreds of hospitals embedded code in their websites that prevented” Internet search engines from “displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.”

That report was done using data provided by Turquoise Health Co. Turquoise gives hospitals a rating of one to five stars for transparency compliance with five stars being the highest rating.

In Oklahoma, Turquoise reports that St. Anthony Hospital in Oklahoma City achieved a compliance score of only two stars, while two Hillcrest hospitals in the Tulsa area received only three stars.

SB 548, which previously gained majority support from the full Oklahoma Senate, passed the House States Rights Committee on a 5-1 vote that broke along party lines with Waldron in opposition.