DENVER (CBS4) – A new bill could protect Colorado consumers from surprise out-of-network medical bills. HB19-1174, introduced in early February, aims to get patients out of the middle, and let insurance companies and doctors duke it out.

(credit: CBS)

It would protect consumers in situations when they didn’t know they were being sent out of network or perhaps did not have a choice.

“Some people are getting liens put on their homes because of these bills,” Rep. Daneya Esgar, a democrat representing Pueblo and co-sponsor of the bill, said. “People are going into medical bankruptcy because of these bills. It’s been a problem for a long time.”

Chuck Woodard knows all about such shocking bills.

Chuck Woodard (credit: CBS)

“This can happen to anybody,” he told CBS4’s Kelly Werthmann.

A couple years ago, his son was involved in a serious accident. He was taken to an in-network hospital, but was later billed for doctor services that were out of network.

“He owed an additional $3,000 on top of his $5,000 deductible,” Woodard explained.

Instead of billing his insurance company, Woodard said doctors billed his son directly, and eventually put the bill in for collections.

“Doctors seem to take an approach that it is easier to put pressure on the consumer than the insurance company,” he said. “That’s not fair.”

Photo of hospital room. (Photo by Jack Kearse/Emory University via Getty Images)

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. It is a big reason why a bi-partisan group of lawmakers has introduced legislation that prohibits out-of-network providers from billing patients in the first place.

Before a house committee Wednesday, many doctors and medical experts voiced their concerns.

“This bill, as written, puts physicians at a substantial disadvantage,” Dr. Dan Downs, a past president of the Colorado Medical Society, said. “If out of network rates are set too low…then insurers don’t have an incentive to negotiate in good faith.”

Yet Woodard said he doesn’t have any empathy for physicians.

“They hired the billing company that went after my son for a bill that the insurance company owed,” he said. “When I complained to the doctors, they blew me off.”

(credit: CBS)

A few fire chiefs also addressed the health and insurance committee, asking for an amendment to make fire EMS exempt.

“If this bill stays the same,” Chief Don Lombardi of West Metro Fire told CBS4, “it’s going to affect our ability to provide a high quality care of service.”

West Metro Fire is among the fire organizations in Colorado that provides fire-based EMS along with ambulances for transport, and is considered a health care provider.

“It costs us about $2,500 to provide that transport. Typically, when we bill for that service, it’s about $1,300 and then when everything is said and done through Medicare or Medicaid commercial payers, we receive about $410 to $440 per transport,” Lombardi explained. “So you can see we’re losing money right now.”

(credit: CBS)

Lombardi said if the bill goes through without the amendment, it would further reduce the dollars they receive for their services, and could potentially mean removing ambulances from the streets.

“We could lose about $5 million per year,” he said. “I’ve either got to go to the taxpayers and ask them to raise taxes to subsidize this medical care, or get more dollars from insurance carriers. If I don’t get either of those, then we have to reduce our service.”

After hours of testimony and Q & A, HB19-1174 passed through the health and insurance committee in a 9-0 vote. It now has to go through an appropriations committee before moving to the House floor.

Kelly Werthmann

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