A Colorado state Senator has introduced a bill that would limit how much individuals can be charged when visiting out-of-network physicians and hospitals in emergency situations. The objective behind the bill is to eliminate what is known as “balance billing,” which occurs when a patient receives a bill for a stay in a hospital that is not part of his or her insurance network.
Similar legislation is being considered in other states. There was the story of the emergency room doctor who was billed $30,000 for life-saving treatment after suffering an injury while surfing. As well, there was the story of the heart attack patient who received a bill for $109,000.
In Colorado, it was a mother who received a $15,000 hospital bill after her son was rush to a hospital following a fall at a local park.
The bill would limit how much a healthcare facility could charge individuals for treatment and procedures to:
- 125% of Medicare’s reimbursement rate
- The average in-network rate for the geographical area
- The average in-network rate as determined by the “All Payer Claims Database”
The bill would only apply to insurance plans regulated by the Colorado Division of Insurance.
The Colorado Hospital Association expressed support for the concept of reaching a compromise between individuals, insurance companies, and healthcare facilities, but said it was worried about the “ripple” effect of this legislation. “Colorado hospitals agree that the status quo is unsustainable, and hospitals are eager to work with the sponsors to find the desired ‘sweet spot,’ but we cannot shift the market so much that insurance companies lack incentives to fairly negotiate,” said Katherine Mulready, the chief strategy officer for the Colorado Hospital Association.