DENVER (CBS4)– Figuring out who is in your health insurance network and who is out-of-network can be difficult and costly. Now, there’s a move to protect Coloradans from surprise medical bills.
Zoe Williams among those supporting the bill. When her daughter broke her leg, she did what any parent would do in an emergency, “On Sept. 1, 2016, I got the text message that no parent wants to get. We traveled by ambulance to Denver Health. We stayed overnight, my child was put in a half-body cast. And it was six of the hardest weeks in my life.”
Williams would only learn later that the ambulance and hospital were out-of-network.
Insurance, she says, refused to pay, “We are over $15,000 in debt.”
In some cases, the surprise bills are the result of an emergency. In other cases, patients get surgery at a hospital that’s in-network, with a doctor who is in-network, only to get a bill from a surgical tech, who the patient didn’t even know would be in the room, who is out-of-network.
Rep. Daneya Esgar, a Democrat representing Pueblo, is among those who are cracking down, “More and more Coloradans are getting hit with these surprise bills.”
A bi-partisan group of lawmakers has introduced legislation that prohibits out-of-network providers from billing patients in the first place. Under current law, patients don’t have to pay the bills if it is an emergency or if there was no way of knowing the provider was out-of-network. But most patients don’t know that and pay the bill.
Adam Fox with the Colorado Consumer Health Initiative says, “Some providers gone so far as to send people to collections, and have liens put on people’s homes. These bills can happen to anyone.”
Rep. Brittany Pettersen, a Democrat representing Lakewood, is a case in point, “I ended up receiving, instead of a bill that should have been $2,200, was $26,000.”
Williams said her insurance ultimately payed her daughter’s bills but only after a six-month battle, “Had we not been willing to fight, our entire financial stability would have been destroyed.”
There are two bills dealing with surprise billing this session. Both of them are bi-partisan. The Colorado Medical Society supports one of them. The Colorado Hospital Association hasn’t taken a position.
Both bills only apply to state-regulated insurance plans. Most plans are federally regulated. However, it can be difficult to differentiate, so lawmakers hope that if one of the bills becomes law, providers will bill insurers not patients regardless of the plan.