CARSON CITY — Doctors in medical scrubs helped fill a legislative hearing room Monday to support a measure addressing so-called “surprise” bills patients receive when they don’t use in-network physicians or facilities.
Senate Bill 289, sponsored by Sen. Joe Hardy, R-Boulder City, would use an independent database of billing practices to determine reimbursement levels doctors would receive for treating patients outside their negotiated insurance networks.
“Surprise! That’s what happens when people get a bill they don’t anticipate getting,” the soft-spoken Hardy, himself a physician, told members of the Nevada Senate Committee on Commerce, Labor and Energy.
High cost for care
Out-of-network charges happen when a patient is treated by a doctor who has not negotiated rates with a particular insurance carrier. It most often occurs in emergency situations.
Sometimes, even when a facility is in-network, an on-call or substitute doctor not in a network may provide treatment, and the patient gets billed the full amount for their services. The charges can add up to tens of thousands of dollars.
The bill would not apply if a patient knowingly goes to an out-of-network doctor or facility.
Hardy said the bill attempts to resolve the problem for patients and ensure continued access to health care.
Under SB289, insurers would reimburse out-of-network doctors at an amount equal to the 80th percentile of charges billed by physicians for a particular service within a given geographical area.
“There is a transparency problem in the industry that has led to gross misperceptions regarding out-of-network billing events,” Dr. Bret Frey, an emergency room physician, said in written testimony.
“If a patient purchases an insurance product with a narrow network, they generally will end up out of network in an emergency, through no fault of their own, because they have a condition that by its nature demands a very specialized level of care, such as stroke, heart attack and trauma.”
The bill was supported by the Nevada State Medical Association, Medical Group Management Association and others.
Insurance groups say no
Insurance groups opposed the bill, arguing it would drive up premiums and patient co-payments.
Keith Lee, representing Nevada Association of Health Plans, said insurers negotiate with patients on out-of-network charges. He and others raised concerns on setting geographic rates and said the bill could cause providers to not negotiate and leave networks.
Lee said his members will work with bill supporters to address concerns but added, “I don’t want raise expectations that we will be able to do so.”
Labor groups, including the Clark County Firefighters Association and Nevada State ALF-CIO, also spokes against it, arguing it would hinder their abilities to negotiate rates.
Damon Haycock, executive officer of the Public Employees Benefit Program, testified as neutral on the bill but raised similar concerns. He said the group plan that covers tens of thousands of state workers and retirees negotiates contracts that provide discounts of around 60 percent of regular charges.
He said there would be no incentive for providers to negotiate as in-network if the discounted rate for out-of-network services amounted to 20 percent.
No action was taken on the bill Monday.
Contact Sandra Chereb at email@example.com or 775-461-3821. Follow @SandraChereb on Twitter.
HELP FOR PATIENTS
Under the Senate Bill 289, insurers would reimburse out-of-network doctors at an amount equal to the 80th percentile of charges billed by physicians for a particular service within a given geographical area.