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Transparency Legislation

There may have been times when you’ve gone to the hospital ER, a clinic or even to a doctor’s office where you were charged with in-network pricing or out-of-network pricing and as a consumer, you may not understand the differences in that pricing or understand your options. You may have even experienced receiving an invoice without the facility explaining charges before services are rendered — and these charges can range from hundreds to even thousands of dollars, so understanding the differences between in-network and out-of-network and understanding your options is vital.  

This billing occurs when consumers have procedures performed or visit ERs that are in their insurance network, then are sent separate invoices from non-network doctors who were involved in your treatment; which these bills typically come from ER doctors, anesthesiologists, and radiologists, among other Specialists that were involved in your treatment or procedures.

There are a few states taking a stance to this type of process.  The way they plan to help eliminate the issue is under House Bill 678.  In the article by Georgia Health News, it states:

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Under House Bill 678, a consumer getting non-emergency services from a hospital, physician practice or treatment facility would, upon request, receive information on whether the medical providers involved are in the patient’s insurance network, what the fees will be, and how much the patient’s policy will pay”, Smith says.

The Proposal would also require insurers to give information to members on obtaining a referral to a healthcare provider outside their network when the health plan does not have a provider in the patient’s geographical area.  It would also make the insurer disclose the amount that would be reimbursed under out-of-network services,” Andy Miller.

This bill will be giving consumers hope by giving them a chance to eliminate medical debt. For consumers that are fortunate enough to afford to pay their medical bills, it still puts a family in a predicament even with insurance.  Another way this new bill will be helping consumers is allowing them 90 days to pay the balance, or at least negotiate payments.

Mr. Smith is trying with his new legislation to ensure that patients get help in making decisions through increased transparency of medical costs. Health care pricing, he said, “is like a black hole’’ for patients. For a more in-depth understanding on this proposed bill, visit:


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