Health Care

Restrictions on ‘surprise’ medical bills advance despite apparent hospital lobbying

March 13, 2020

Ray Carter

Legislation that would protect Oklahomans from inflated “surprise” medical bills has advanced from the state Senate despite apparent lobbying in opposition by hospital officials.

The measure advanced on a party-line vote with only Democrats in opposition—including two Democratic lawmakers who previously supported the reform in committee, including one who had previously praised the measure.

Senate Bill 1646, by Sen. Julie Daniels, would protect Oklahomans from facing collection agencies for medical bills in instances where providers fail to provide pricing information prior to a procedure.

“This is another layer of protection for the health-care consumer, that they should be on notice and agree to, up front, the cost of the services they’re going to receive,” said Daniels, R-Bartlesville.

Under the bill, if a hospital provides up-front pricing and the consumer does not pay, the debt may be turned over to collectors and can cause a reduction in the patient’s credit score. But if the provider does not provide up-front pricing and instead gives the patient a “surprise” bill at the end of the procedure, the patient is protected. The hospital would not be allowed to report the resulting healthcare debt to a credit bureau or pursue collection activities.

The problem of “surprise” medical bills that are often wildly inflated has been growing nationwide, and Oklahoma has not been an exception.

One in five emergency room visits in Oklahoma resulted in an out-of-network charge in 2017, which is higher than the national average, according to the Peterson-KFF Health Care Tracker.

When Oklahoma Watch reviewed court records for recent years, it found dozens of Oklahoma hospitals filed at least 22,250 lawsuits against former patients over unpaid medical bills. Many of those bills fall into the “surprise” category, and in many instances the individuals being sued have insurance.

There are some indications certain providers have made “surprise” billing part of their business model. Oklahoma Watch found the Saint Francis Health System accounted for 22 percent of all state hospital lawsuits against patients. A review of hospitals’ publicly available reported financial data from 2017, conducted by the 1889 Institute, found Saint Francis enjoyed an overall 17.5 percent profit margin.

Lawmaker comments during the Senate floor hearing on SB 1646 indicate large hospitals have been lobbying against passage of the consumer-protection measure.

“Have you consulted the hospital association and have they taken a position on this?” asked Sen. Michael Brooks, D-Oklahoma City.

“I have met with the health care authority representatives and the hospital association, and I know the anesthesiologists are very interested in this,” Daniels said. “Obviously, the people within the health care system would see this as a way to complicate their lives, so I absolutely expect them to push back and to want to carefully negotiate the language in this bill when it goes to the House. So, yes, I’m aware of all of those who might take a different view of this bill. But again, the purpose of this bill is consumer protection, consumer information.”

SB 1646 previously passed without opposition in the Senate Committee on Retirement and Insurance. Brooks and Sen. Kevin Matthews, D-Tulsa, were among the lawmakers who supported the legislation at that time. Matthews even spoke in favor of the bill, saying he knows people who have received treatment 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.

But when SB 1646 was heard on the Senate floor, it passed on a party-line, 35-9 vote. All opponents were Democrats, including Brooks and Matthews.