Holmes Plan Would End Surprise Billing

COLUMBUS – Surprise medical bills – those unexpected charges that can cost patients hundreds or even thousands of dollars – would become a thing of the past under legislation being proposed in the Ohio House of Representatives.

The measure, introduced today by State Representative Adam Holmes, would end the days of consumers being blindsided by unexpected bills.

“More and more Ohioans are being stuck with surprise medical bills. They deserve action,” said Holmes (R-Nashport). “This legislation is about people, it’s about patients. When you or a loved one is recovering from surgery or a procedure, the last thing you need is more surprises. It’s time to stop playing ‘gotcha’ with patients and let them focus on getting well.”

A “surprise” medical bill is an unexpected bill a patient receives from an out-of-network health care practitioner, such as an anesthesiologist, after receiving care in a hospital or facility that’s in the patient’s insurance network. Because the health care practitioner is out-of-network, patients can be left holding the bill for additional costs not covered by insurance.

One of the things especially frustrating about surprise billing, Holmes said, is that patients often believe the health care professionals caring for them are all in-network.

“Many times, they don’t find out until they receive a surprise bill in the mail,” Holmes said.

According to Stanford University researchers, surprise billing is on the rise across America and so is the expense, with average costs tripling over a seven-year period to more than $2,000 per bill.

A recent poll found that one third of privately-insured Ohioans report having received a surprise medical bill.

The bill represents a free market solution to the problem of surprise billing. Under the legislation, an out-of-network health care professional, who provides care during an in-network procedure, could elect to be paid the in-network rate by the insurance company or could negotiate a different rate with the insurance company.

If no agreement is reached, the health care provider can pursue “baseball style” arbitration. Under this approach each side would submit documentation supporting their position to a neutral, third party arbiter who would make a final, binding decision.

The key, Holmes said, is that regardless of how the issue is decided, it would be resolved between the provider and the insurance company – without the patient being stuck in the middle.

Nearly eight in 10 Americans support legislative action to protect patients from surprise medical bills, according to a recent Kaiser Family Foundation poll, which found strong support among Democrats, Republicans and independents.

“It’s time to bring consistency and clarity to a complex issue,” Holmes said. “This legislation will protect consumers and give them the peace of mind they deserve,” Holmes said.