Health Care

Surprise medical billing protection clears committee

February 26, 2021

Ray Carter

Oklahomans would be protected from having debt collectors hound them for surprise medical bills under legislation that has cleared a state Senate committee.

Senate Bill 548, by Sen. Julie Daniels, prohibits medical providers from turning a health care expense debt to a credit bureau or collection agency unless the medical provider “can demonstrate that the person liable for the medical debt was presented with and agreed to a good faith estimate of the total cost of all healthcare services to be provided prior to agreeing to receive the services.”

“This is a consumer protection bill—specifically, a health-care consumer protection bill,” said Daniels, R-Bartlesville. “It is designed to make sure that a consumer will not be surprised by a report of medical debt to a credit bureau or surprised to be called by a collection agency because they didn’t know the cost of the service they were to receive.”

Daniels noted research indicates over 50 percent of U.S. bankruptcies are tied to medical debt.

“The rise in hospital prices has outpaced economy-wide inflation for decades and, as Harvard economist Leemore Dafny says, when price isn’t tightly linked to cost, that is a sign the market is not competitive,” Daniels said. “So another benefit of this bill could be to create more intelligent health-care consumers who might then go and look at where there are competitive prices for the service they are about to receive and slowly bring down the cost of health care to all.”

The legislation requires that the total cost estimate include all services performed by the medical provider as well as any authorized services provided by a contractor, affiliate, or any other third party who provided services in the facility, including out-of-network providers.

In situations where a patient is brought to an emergency room and an estimate cannot be provided prior to treatment, SB 548 limits the patient’s liability to no more than 150 percent of the Medicare rates for the emergency services rendered.

If a medical provider does not provide an advance estimate of cost, the legislation provides patients with the right to obtain “dismissal of any collection suit or garnishment proceeding” resulting from the cost of treatment.

Some lawmakers appeared hesitant to support the bill.

Sen. Greg McCortney, R-Ada, questioned if the language of the bill was too vague to be effective, such as defining a “good faith” estimate.

Sen. Jessica Garvin, R-Duncan, suggested many medical officials cannot provide valid cost estimates.

“I just want to make sure that we are not requiring billing specialists of any type to be on site or on location 24-7, because a clinician is not going to have access to financial information 24-7,” Garvin said.

Daniels noted the cost of routine medical treatments and procedures can be easily calculated by medical providers, and that the bill treats true medical emergencies differently than non-emergency care.

She also noted the bill is designed to benefit the average Oklahoman.

“It’s consumer protection, not health care system protection,” Daniels 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.”

Both McCortney and Garvin ultimately voted in favor of the bill.

“People being able to know what it is going to cost is important,” McCortney said, “and we’ve got to find a way to reduce costs in the health care system.”

Sen. Adam Pugh, R-Edmond, said when his second child was born, he did not have insurance and paid cash for the child’s delivery. That experience highlighted the arbitrary and wildly inflated cost of health care.

“I went to the cashier’s desk to be able to pay my bill so I could go home with my child. The bill was presented to me for the first time what that cost was going to be,” Pugh said. “And I said, ‘Okay, I’m going to write you a check.’ And looking somewhat astonished, the cashier took the bill back from me—true story—crossed the line through what I owed, halved it, and that is the check that I wrote to the hospital.”

Pugh noted health care is the second-most impactful economic decision people make aside from buying a home, “and they have no idea how much it’s going to cost them when they walk into the door of a doctor, a health care facility, a hospital, you name it. No idea up front.”

Sen. Joe Newhouse, R-Tulsa, raised a similar critique.

“If you go to buy real estate property using a mortgage, they have to provide you a good-faith estimate,” Newhouse said. “They want to make sure that you know the costs that you’re getting into. Why can’t we do the same thing for health care?”

Supporters said the need for price transparency is apparent in health care, and predicted SB 548 could begin to force more providers to move that direction.

“The idea that a consumer has the right to know how much they’re going to be asked to pay for a service should not be earth-shattering in any industry,” Pugh said. “Yet I keep being told that it’s an impossibility in health care. Why? The less you know as a consumer, the easier it is for that cost to just continue to go up.”

SB 548 passed the Senate Business, Commerce and Tourism Committee on a 12-1 vote. Only Sen. George Young, D-Oklahoma City, opposed the legislation.