Law & Principles

Ray Carter | February 25, 2020

Protection against ‘surprise’ medical billing advances

Ray Carter

Oklahomans would be protected from having credit scores reduced as the result of “surprise” medical bills under legislation that has gained strong bipartisan support in a Senate committee.

Senate Bill 1646, by Sen. Julie Daniels, would prohibit any medical provider from reporting a healthcare debt to a credit bureau or pursuing collection activities unless the provider “can demonstrate that the person liable for the medical debt was presented with and agreed to the total cost of all healthcare services to be provided prior to agreeing to receive the services.”

Daniels said the bill is about “protecting patients from surprises in billing, protecting their credit scores, and requiring all manner of health-care providers to make a good-faith effort to give them an estimate of the cost of services up front.”

“It’s a very broadly written bill at this point, and I know it needs a lot of conversation, but I would certainly hope this year to get started on some sort of meaningful reform that will help protect these citizens who find themselves suddenly facing collection agencies or have compromised their credit score because they were unaware of the full cost of the medical care that they were going to receive,” said Daniels, R-Bartlesville.

Failure to comply with the law would be considered “grounds for dismissal of any collection suit or garnishment proceeding” under the bill.

While certain medical facilities may be listed as “in network” providers by an individual’s insurance policy, specific practitioners at that same facility may be considered “out of network” by the insurer. As a result, many people have received “surprise” medical bills in recent years that reflect much higher out-of-network rates.

Daniels noted it is increasingly difficult for even the best-educated consumers to obtain medical pricing information in advance, and said consumers should not have their credit ratings lowered when there is no way to obtain reliable advance billing information.

“I know of one family where the lady needs a blood test, and she’s actually gone out and asked, and has two differing answers from the insurance provider as to whether or not it’s in network, out of network,” Daniels said. “This for a $3,000 test, and this is somebody who has the wherewithal to ask upfront, had the knowledge to know that she should ask, but of course we know many patients don’t have that.”

Sen. Kevin Matthews, D-Tulsa, said he knows people who have had treatment that they thought was covered by insurance and “found out later these collection agencies are calling.”

“When your credit is affected and you don’t even know it, it’s causing unnecessary harm on top of this,” Matthews said.

Ironically, Daniels noted those without insurance are often able to obtain better advance information on the cost of medical services.

“If you are in situations where you don’t have insurance, it’s almost easier if you go into a hospital for a procedure that you could sit down with the hospital billing people ahead of time and sort of come up with an estimate of what it’s going to cost, and then perhaps even a payment plan,” Daniels said. “Actually having insurance complicates it even further.”

Sen. Marty Quinn, R-Claremore, noted that the Oklahoma Health Care Authority, the state’s Medicaid agency, has said the bill would have a financial cost to the Medicaid program.

“Have they discussed with you why it is a fiscal impact?” Quinn asked.

“The issue, they say, is what if somebody has a medical procedure, they think they’re covered by Medicaid only to find out they’re not,” Daniels said. “Then, of course, they’re owing that money, and that goes against their credit score, and the collection agency will come after them, and those, of course, are the most vulnerable people.”

However, Daniels questioned whether the agency’s claim is accurate.

SB 1646 passed unanimously in the Senate Committee on Retirement and Insurance.

Ray Carter Director, Center for Independent Journalism

Ray Carter

Director, Center for Independent Journalism

Ray Carter is the director of OCPA’s Center for Independent Journalism. He has two decades of experience in journalism and communications. He previously served as senior Capitol reporter for The Journal Record, media director for the Oklahoma House of Representatives, and chief editorial writer at The Oklahoman. As a reporter for The Journal Record, Carter received 12 Carl Rogan Awards in four years—including awards for investigative reporting, general news reporting, feature writing, spot news reporting, business reporting, and sports reporting. While at The Oklahoman, he was the recipient of several awards, including first place in the editorial writing category of the Associated Press/Oklahoma News Executives Carl Rogan Memorial News Excellence Competition for an editorial on the history of racism in the Oklahoma legislature.

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