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Experience. Integrity. Advocacy.

Indiana General Assembly Tackles Surprise Billing

Indiana General Assembly Tackles Surprise Billing

While the U.S. House and Senate continue to debate possible solutions to surprise billing on the federal level, here in the Hoosier state the Indiana General Assembly has taken matters into their own hands with a new House bill recently approved by a 99-0 vote. 

House Bill 1004

House Bill 1004, sponsored by Rep. Ben Smaltz, R-Auburn, prevents out-of-network healthcare providers from billing patients more than the in-network rate set by their insurance company if the services were performed at an in-network facility. The bill has been referred to the Senate, where it will be considered by the Committee on Health and Provider Services, which recently approved its own Senate Bill 3, which also addresses balance, or surprise, billing.

“Moving this proposed legislation across to the Senate is just another hurdle cleared as we try to protect Hoosiers from this unfair practice,” Smaltz said in a statement after the vote. “Hoosiers should not be burdened with the possibility of a surprise and many times costly bill when seeking medical attention at an in-network provider.”

Exceptions and Limitations

Unlike SB 3, HB 1004 does include an exception. Providers may balance bill patients for out-of-network services at in-network facilities if they inform the patient that the services will be out-of-network, provide an estimate of the total charges, and get the patient’s signed consent at least five days prior to a scheduled service.

According to Indianapolis Business Journal’s Lindsay Erdody, one limitation of HB 1004 is that it likely would not affect self-funded insurance plans in the state, which cover roughly 43 percent of Hoosiers, as those fall under federal regulation. 

Regardless, Smaltz believes the legislation is still worth exploring.

“You have to do what you can, where you can, for who you can… and don’t get lost in it doesn’t cover everybody,” Smaltz told IBJ.

Federal Efforts

Meanwhile, The Hill reported earlier this week that U.S. House Speaker Nancy Pelosi met with House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) and House Ways and Means Committee Chairman Richard Neal (D-Mass.) to convince them to find a middle road between their two approaches to solving surprise billing.

While both approaches seek to protect patients from surprise billing, the two approaches vary in how providers would be paid. Insurance companies prefer the bipartisan proposal from the Energy and Commerce Committee, which would set payment rates based on the median in-network rate for services in that area. 

Providers, on the other hand, favor the proposal from the Ways and Means Committee, which relies on baseball-style arbitration, where both sides submit their best offer and an outside arbiter selects one as the payment rate.

And these are just two of the many proposals emerging from the House and Senate in recent months. While a solution looked promising last summer, more and more proposals, along with extensive lobbying by both payer and provider groups, have muddied the water.

“We have to end surprise medical billing,” a spokesperson for Energy and Commerce Republicans told The Hill. “It’s simply not fair for patients. If everyone engaging on this issue accepts that premise, then we can solve this problem. Let’s get this done.”

Learn More

To learn more about state and federal efforts to address surprise billing, check out the following resources:

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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