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Lawmakers to Consider Protections from Surprise Medical Billing

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Colorado lawmakers are considering a measure that would require out-of-network health providers to add language to their bills that explain consumer rights under state law. (Pixabay)
Colorado lawmakers are considering a measure that would require out-of-network health providers to add language to their bills that explain consumer rights under state law. (Pixabay)
 By Eric Galatas - Producer, Contact
April 11, 2018

DENVER - A new bill introduced in the Colorado Senate is designed to help protect consumers from so-called surprise medical bills.

Frequently, said Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, patients with insurance end up getting billed for services from out-of-network providers even if the care was given at an in-network hospital or clinic. He said most consumers aren't aware of protections already in place under state law.

"And that's really the issue," he said. "We're trying to make sure that consumers know their rights and legal protections, and can take the appropriate actions to make sure that they're paying the bills that they're responsible for, and not paying ones that they aren't responsible for."

Senate Bill 237 would require out-of-network providers to include plain language on their bills that lay out consumer rights, which can include not having to pay the additional balance if their insurance company is regulated by the state.

Plans regulated at the federal level are not subject to the same protections. Similar measures introduced in past sessions were not popular with insurers who were concerned they might get stuck with the bill, and providers worried they might not get full payment for their services.

Fox said it can be frustrating for people who do their best to schedule appointments with in-network hospitals and clinics, only to be hit with a bill above and beyond what their insurance company has agreed to pay. He explained it is technically up to the insurance company to make good with out-of-network providers who are not on hospital staff or provide specialist services, but that hasn't stopped providers from coming after patients to collect.

"In what other industry can you send a bill to a consumer that they don't technically owe, and collect on it, and potentially send them to collections for non-payment?" he asked. "That's what's happening right now in Colorado."

The measure does not prohibit surprise balance billing outright, but Fox said it's a step in the right direction.

SB 237 was introduced by Sen. Bob Gardner, R-Colorado Springs, and Rep. Daneya Esgar, D-Pueblo. Its text is online at leg.colorado.gov.

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