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1/9/2020 Rep. Shanley legislation seeks to limit surprise billing for out-of-network health care services
STATE HOUSE — Rep. Evan P. Shanley (D-Dist. 24, Warwick) has introduced legislation that would change the way out-of-network health care professionals are paid after rendering services to patients who didn’t have the opportunity to select such health care services from in-network professionals.

“Surprise medical billing occurs when a patient seeks treatment at an in-network facility, only to discover later on that they have received treatment from out-of-network medical professionals who are not employees of the facility,” said Representative Shanley. “Sometimes hospitals, emergency rooms and clinics are staffed by care providers who are employed by an independent company that contracts with the facility.”

Since some insurance plans offer little to no out-of-network coverage, patients can get hit with all sorts of surprise bills that are considerably higher than what they were led to believe they would be charged.

The bill (2020-H 7042) would provide a method for the reimbursement to out-of-network professionals who provide unanticipated care and would provide guidelines for what payment those professionals may seek or accept from a patient for unanticipated out-of-network care.

The legislation aims to make surprise billing a rare event, by clearly defining unanticipated and anticipated out-of-network care and by allowing patients to get written cost estimates before undergoing surgery or non-emergency, facility-based procedures. The bill further says that no health insurance carrier may require prior authorization for rendering emergency services to an insured patient. The legislation also prevents balance billing, which is when patients are billed for the amount in excess of what a doctor might get paid in a negotiated settlement. Under the provisions of this legislation, no health insurance carrier would be able to impose a coinsurance, copayment, deductible or other out-of-pocket expense that is greater than those that would be imposed if such services were rendered by an in-network health care provider.

The bill also contains a provision for the nonprofit American Arbitration Association to resolve disputes between the out-of-network provider and the insurance carrier through binding arbitration, and it prevents the health care professional from billing a patient while the claim is being negotiated or arbitrated.

The legislation, which is cosponsored by Representatives Karen Alzate (D-Dist. 60, Pawtucket), Joseph J. Solomon Jr. (D-Dist. 22, Warwick), Raymond H. Johnston Jr. (D-Dist. 61, Pawtucket) and Deborah Ruggiero (D-Dist. 74, Jamestown, Middletown), has been referred to the House Committee on Health, Education and Welfare.

For more information, contact:
Daniel Trafford, Publicist
State House Room 20
Providence, RI 02903