Proposed bills aim to stop surprise hospital billing, add price transparency

Posted at 6:16 PM, Apr 20, 2022
and last updated 2022-04-20 20:26:27-04

DENVER — Between the immediate health concerns and the long-term financial worries, hospitals can be a scary experience.

Danielle Duchateau knows the trepidation that comes with hospitals firsthand. In 2016, she was involved in a serious car wreck. Unconscious, she was taken to the hospital for treatment.

Her bill ended up totaling $21,000, of which she was responsible for $8,000 while her insurance took care of the rest.

“A few months later, I was shocked to receive a bill for $12,000,” Duchateau said. “I didn't understand since I had gone to an in-network hospital.”

Through a lot of effort, letters and phone calls, she was eventually able to dispute the charge successfully. However, Duchateau says she lived with fear for quite some time because the hospital threatened to send her to collections over the bill.

She worried about her credit and whether she would lose her health insurance as a cancer survivor. But more than anything, she felt like what the hospital did was unfair.

“When people are treated in the emergency room, they should be able to focus on healing and not have to worry about bills,” Duchateau said.

In 2019, Colorado lawmakers passed a bill to add consumer protections around surprise billing in the state. The following year, Congress passed its own version of patient protection laws with the No Surprises Act. That law went into effect on Jan. 1, 2022, and protects consumers from surprise emergency and some non-emergency services.

In some instances, the federal and state laws did not line up and actually conflicted with one another. In an effort to clear the confusion, this year, state lawmakers are debating a bill to align the two.

Among other things, House Bill 22-1284 would allow people to request an external, independent review of a charge for an out-of-network provider to see whether it can be charged at an in-network level.

“It literally takes the state bill and the federal law [and] puts them together to make sure that they merge into one simple set of facts for carriers, for providers and for patients so nobody gets confused as to what their rights are,” said House Majority Leader Daneya Esgar, D-Pueblo.

The bill would require a carrier to provide a disclosure to a covered individual about the possible impacts of receiving services from an out-of-network provider or at an out-of-network facility, and also set guidelines for arbitration.

“You and your family are not going to be strapped with an astronomical bill for an out-of-network surgeon, an out-of-network anesthesiologist who you have no idea if these people are in your network in a time of need,” Esgar said.

Adam Fox from the Colorado Consumer Health Initiative supports the bill, saying it sets out clear parameters for out-of-network care charges and expanding the surprise billing protections.

“In 2019, we were really only able to protect a third, maybe a little more than that of Coloradans with our surprise billing protections," Fox said. "This really makes those protections blanket protection for all Coloradans, regardless of their insurance coverage."

Duchateau testified in favor of the bill at its first committee hearing, saying it can help people in similar positions avoid the hassle of disputing the charge.

The bill has bipartisan support, as well as the support of CVS Health, AARP, Healthier Colorado, Mental Health Colorado and other health groups. There has been no outspoken opposition.

Meanwhile, a second bill also aimed at hospital costs would tackle pricing transparency.

House Bill 22-1285 would prohibit hospitals from pursuing collection actions against a patient if the hospital was not in compliance with federal price transparency laws when the patient was treated. It would also allow those patients to take legal action against the hospital for being out of compliance.

“If a hospital tries to send them to collections or tries to sue them for their bill, they can then have recourse against that,” said Rep. Patrick Neville, R-Douglas.

It’s a bill David Kochel and his son, Mason, support. Mason has a severe tree nut allergy and ended up in the hospital last year when he inadvertently ate a pasta sauce that used cashew butter. The college student went to the hospital, was treated and sent home with an Epi-pen, something he’s gone through a few times before.

“A couple of months later, he gets the bill for the Epi-pen, for the overall visit and the Epi-pen, [and] was charged at $15,043,” David Kochel said.

Mason called his parents in a panic over the bill. His father knew of a group that helped dispute hospital bills, and through a lot of work and digging, they were able to determine that the Epi-pen should have been billed at $600.

“We wrote a pretty detailed letter to the hospital, and they wrote back kind of embarrassed and apologized and actually waived the entire cost of the visit,” he said.

The father and son both support the legislation because they say it empowers consumers to hold hospitals accountable. They hope that if it passes, patients won’t have to go through all of the worry and work they did in order to appeal a hospital bill.

For non-emergency situations, the price transparency bill would allow patients to shop around at different hospitals for the best price for a procedure, something Neville says will help lower costs by imposing market forces on healthcare. He also hopes this will end some of the cost negotiating between hospitals and insurance providers, since the prices will be transparent.

Hospitals can already face penalties under federal law for not complying with price transparency standards, but Fox says federal regulators can be slow to enforce things.

“Sometimes you get laws passed, state or federal, that don't really incorporate the necessary capacity to oversee that,” Fox said. “I think, really, this is about accountability on the part of hospitals to their communities.”

This bipartisan bill would allow patients to take matters into their own hands, something Neville believes is better than creating a new state government office to try to enforce laws. He hopes it will force immediate compliance.

Neville knows this bill won’t completely alleviate all of the concerns consumers have over hospital pricing, but he insists it’s a start.

“Transparency won't solve all the problems in healthcare, but nothing can be solved without it,” he said.

While HB22-1285 does have bipartisan support, business groups like the Colorado Chamber of Commerce and Colorado Competitive Council are opposing it, as is Denver Health.

Both bills are still making their way through the state legislature.