AFN file photo

It won't stop unexpected medical bills, but legislation approved last week by the state Senate is designed to give Arizonans a chance to fight having to pay them.

Sen. Debbie Lesko, R-Peoria, said SB 1441 will help with situations where someone goes into the hospital and is tended to by an out-of-network doctor.

"If it's a scheduled procedure they have gone in to make sure that the doctor takes their insurance, they've checked to make sure the hospital takes their insurance and they think they're all set,'' she said.

"A month later they get a bill from a doctor that's out of network,'' Lesko said. "And they had no control over it.''

The most common situation, she said, is that a hospital has contracted with an anesthesiologist. But not being an employee of the hospital, that person submits a separate bill to the patient.

Under current law, Lesko explained, the patient has nowhere to turn as the doctor wants his or her money and the insurance company says it won't pay.

The bill does not automatically excuse the patient from that balance billing. Instead, it sets up a procedure for people to ask the Department of Insurance to intervene and determine what's really a fair charge.

It would not apply in all situations.

State intervention would be available in cases where the service was provided in an emergency situation and the patient had no way to check which doctors are within his or her network.

For other situations, arbitration is available if the health care provider did not tell the patient up front that it is not within the patient's insurance network, did not provide the estimated total cost to be billed, and did not give the patient a chance to waive any rights to dispute the bill.

"If they receive a surprise medical bill they would call the Department of Insurance,'' Lesko explained. That agency would set up a phone call involving the doctor, the insurance company and the patient.

"In Texas, 94 percent of all the complaints are settled over the phone,'' she said. "They settle on the amount and it's over.''

Lesko said the way her legislation is crafted, the patient in most situations would be responsible only for the normal co-pay and deductible.

Lesko acknowledged that an argument could be made that a patient should have to pay nothing if he or she has not agreed to out-of-network treatment and suddenly gets a bill. But she said such a proposal would never get approval because of opposition from doctors.

Despite the 25-5 vote, doctors are still lobbying to kill the measure, at least in the form it's in. And they convinced several senators to oppose what Lesko wants.

Even if Lesko can get her bill through the House, where it now goes, none of this will help patients for the rest of this year or even next year. The legislation gives the Department of Insurance until 2019 to set up the rules and procedures for the review process.

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