In May, the Ohio House of Representatives approved an amendment to House Bill 166, the biennial state budget legislation, which would remove Ohio patients from the middle of payment disputes and provide fair and reasonable reimbursement rates for out-of-network providers based on a market rate. However, the House’s provision was removed by the Ohio Senate, and replaced with language that would employ a highly inflated reimbursement rate and an arbitration process that would result in higher health care costs. The issue will be determined this week by a bicameral budget conference committee.
“Every day we hear the stories of Americans who receive bills they cannot afford to pay after receiving services at a facility within their health insurance network,” said Miranda Motter, OAHP president and CEO. “The Ohio General Assembly has a historic opportunity to lead on this issue, and we implore members of the conference committee to seize this moment by restoring the House language to address surprise billing.”
According to a June 20 Kaiser Family Foundation Study about one in six Americans were surprised by a medical bill after treatment in a hospital in 2017. On average, 16 percent of inpatient stays and 18 percent of emergency visits left a patient with at least one out-of-network charge. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital.
In addition to OAHP, other Ohio organizations are speaking out in favor of the House language to limit surprise billing.
“We support a meaningful solution to protect consumers from the burden of costly, surprise bills after they receive care from an out-of-network provider they reasonably assumed was in their network,” said Keith Lake, vice president for government affairs for the Ohio Chamber of Commerce.
“Both the House-passed and Senate-passed versions of HB 166 seek to address this issue. However, we are opposed to using arbitration to resolve these billing disputes and would like to see a benchmark reimbursement rate established in statute. That rate should be based on either 1) amounts the provider accepts from all payers, 2) average in-network rates, or 3) government payment fee schedules. The rate should not be one based on billed charges.
“The Ohio Association of Health Underwriters firmly believes that it’s imperative that the final version of H.B. 166 prevent balance billing in the event of services provided at an in-network health care facility by an out-of-network provider when the patient has no ability to choose an in-network provider,” said Barbara Gerken, OAHU’s legislative chair. “OAHU is opposed to using arbitration as a process to resolve balance-billing disputes. We are concerned that an arbitration process would be time-consuming and costly and result in delays in resolution of disputes.”
The Ohio Association of Health Plans (OAHP) represents 15 member plans providing health insurance coverage to more than 9 million Ohioans. Ohio’s health plans include commercial insurers, Medicaid Care Coordination Plans and Medicare Advantage Plans. As the statewide trade association for the health insurance industry, our core mission is to promote and advocate for quality health care and access to a variety of affordable health benefits for all Ohioans.