Georgia lawmakers approve limiting unexpected medical bills

Some patients in Georgia could soon get a reprieve from receiving unexpected medical bills under legislation heading to Gov. Brian Kemp’s desk, after it received final passage in the state Senate on Wednesday.

House Bill 888, passed unanimously by the Senate and by a vote of 164-4 in the House in March, would require insurers in many cases to pay for care by a doctor or at a hospital that is not within their network of medical providers. It also would limit patient liability for any costs.

“This will let the health care providers and insures take the consumer, the patient, out of the middle and take care of it,” Sen. Chuck Hufstetler, a Republican from Rome, said Wednesday.

Kemp has previously expressed support for the legislation, declaring it a top priority in his State of the State address in January.

Lawmakers have been trying to tackle the issue for several years without success. But the effort gained momentum this session, despite a three-month pause in business brought on by the coronavirus. The session was put on hold in March and resumed Monday.

Surprise bills, which can run up to tens of thousands of dollars, can come about when patients in an emergency end up at a hospital that’s not in their insurer’s network. Or a patient may have surgery at a hospital in network, but an anesthesiologist or other doctor that helped with the procedure is not in network.

The legislation would protect patients from financial responsibility beyond what they would normally have to pay in coinsurance, a copay or deductible.

Roughly one in every 6 emergency room or hospital visits results in a surprise medical bill, according to a study released last year by the nonpartisan Kaiser Family Foundation.

Over half the states in the U.S. have laws that prohibit or limit surprise billing. But like the proposal in Georgia, their reach is limited because states don’t have jurisdiction over most health plans sponsored by large employers. Those plans cover about 100 million people and operate under federal law.