Proposed Ban on Balance Billing Stirs Debate Among Lawmakers, Health Reps

Jan 31, 2018

A bipartisan bill to deal with balance billingor the practice of charging patients for the "balance" of out-of-network care they receive at in-network facilities – stirred up debate among healthcare providers, insurance reps and members of the House commerce committee Tuesday afternoon.

A key issue raised during the hearing was how to resolve disputes between doctors and insurance carriers over how much a patient should be charged for care. Insurance carriers suggested using an average rate as a fallback if both parties couldn’t reach an agreement, but hospitals and doctors said that wouldn’t be fair to their side.

Rep. Neal Kurk and other cosponsors of the bill said they tried to come up with a solution that took the burden of resolving the issue off of patients’ shoulders while also avoiding a situation where the state would be directly setting prices on medical care.

“Each side knows that if they don’t come to a solution, they’re going to the insurance commissioner – who will say only this is commercially reasonable, or this is not commercially reasonable,” Kurk told the committee, explaining the proposed dispute resolution process on Tuesday. “If he says it’s not commercially reasonable, they’ve got to go back to the bargaining table.”

The committee gave the bill an initial greenlight, but it still has a long road ahead before it takes effect. It has the backing of Gov. Chris Sununu and a rare endorsement from the New Hampshire Insurance Department, but still faces an uphill climb amid opposition from physicians groups and other healthcare providers.

House commerce committee killed earlier proposals to ban balance billing, largely at the urging of health industry representatives. This year’s bill was presented as a compromise, meant to take into account the concerns of hospitals and other providers involved in a study committee examining the issue last fall.

Even so, Commerce Chairman Rep. John Hunt seemed skeptical about the plan after hearing from doctors and others who said it would hamper their flexibility and could make it harder for hospitals to find providers in certain specialties.

“The reason why I killed it [in the past] is because there was always — the doctors say don’t do it, the hospitals say don’t do it, the insurance companies were never too excited about it, and patients are going to keep getting screwed,” Hunt said at Tuesday’s hearing.

“But there wasn’t a good process that brought us to this point, now there has been,” his colleague, Rep. Ed Butler, countered.

“We’ll see,” Hunt said. “Won’t we?”