By CELIA LLOPIS-JEPSEN, Kansas News Service
TOPEKA — A flurry of proposals in the Kansas Statehouse this session take aim at rising medical costs, including one that may be the state’s first attempt to rein in “surprise bills.”
Republican Sen. Richard Hilderbrand has introduced two price-transparency proposals and Democratic Sen. Barbara Bollier unveiled a plan to join 28 other states with consumer protection laws against such bills.
Surprise bills come, for example, when you’re being treated in-network but an out-of-network medical professional gets involved. To collect more than your insurer will pay, the out-of-network providers send you extra bills directly.
Kansas may be a hotspot for surprise bills, according to the Kaiser Family Foundation. Only Congress can fix the issue completely, because states can’t help people with many job-based health plans that fall under federal jurisdiction.
Still, slow progress in Washington, D.C., has spurred states to pass at least partial fixes. In Kansas, any partial fix could shield more than 600,000 people on state-regulated health plans.
Nationally, Yale University researchers estimate that limiting surprise bills could save tens of billions of dollars a year in health care spending.
Here’s a quick look at the ideas from Bollier and Hilderbrand.
A partial ban
The proposal from Bollier, who’s running for an open U.S. Senate seat this year, would require the insurer and biller (say, a doctor or hospital) to duke it out without sending surprise bills to the patient.
The biller could accept the insurer’s median in-network payout for the procedure, or try negotiating upward. If talks fall apart, an independent mediator would side with the more reasonable offer, and the loser would pay for the mediation.
Bollier, a doctor from Mission Hills, argues her legislation would keep prices fair for providers and patients alike.
“The actual patient doesn't end up in debt — and unexpected debt,” she said, “when they have done everything right to the best of their knowledge.”
Jack Hoadley, a professor emeritus at Georgetown University’s Health Policy Institute, tracks surprise billing laws and said many states fall short of addressing the matter adequately.
A good law, he said, needs to cover both emergency care and in-network hospitals. It needs to clarify that insurers and billers must settle up without involving the patient, and how to do so.
On first read, he said, Bollier’s plan appears to hit the mark. But it’s unclear whether the bill will get a hearing in the GOP-controlled legislature. Inquiries to insurance committee chairman Sen. Robert Olson went unanswered.
The Kansas Hospital Association and Kansas Medical Society said they are reviewing the bill and haven’t taken positions.
One of Hilderbrand’s proposals would let patients request price lists for the most common services at their hospitals or doctor’s offices. The other bill would entitle them to price estimates for any treatments or services expected to cost more than $500.
Health care providers wouldn’t be bound by the figures, but required to make a “good faith effort” at projecting their prices.
“These aren’t silver bullets,” the southeast Kansas senator said, “but it’s a small piece of the puzzle.”
Insurers would clarify for patients what the final charges would likely be (based on the estimate, and how the insurer and patient would split the bill.
The Kansas Medical Society said the idea is “well-intentioned,” but argues it wouldn’t necessarily give an accurate picture of out-of-pocket costs for several reasons. For example, a single surgery can involve several different billers — the hospital, the surgeon, the anesthetist.
The Kansas Hospital Association had similar objections and said hospitals already work with patients to help them understand how much things cost, such as when planning for a birth.
Also, hospitals are federally required to publish online chargemasters, a kind of price list.
However, chargemasters often contain jargon and shorthand that patients can’t easily navigate on their own, and they don’t reflect what hospitals ultimately charge insurance companies.
Hospitals are fighting a federal push to reveal those much more common and telling rates, the Wall Street Journal has reported. Health care providers and insurers consider them proprietary.
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @Celia_LJ or email her at [email protected] The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on the health and well-being of Kansans, their communities and civic life.