Arizona, 2 Other States Deal With Surprise Medical Bills
Imagine you have to go to the hospital for a procedure. You’ve checked to make sure your doctor is in your insurance’s network. But the anesthesiologist might not be, same with a radiologist or a pathologist. That means when you get your bill, it might include higher out-of-network costs.
State lawmakers are considering a bill that would set up an arbitration procedure for patients who find themselves in that situation. Arizona Sen. Debbie Lesko is the main sponsor of SB 1441.
"What happens now is the patient has to — they call the doctor and they say 'hey what’s going on,' then the doctor says 'call the insurance company,' the insurance company says 'oh that doctor’s out of network.' And back and forth and back and forth, and the patient who sometimes is ill and sick is stuck with this," said Lesko during the Senate vote on the bill.
Under Lesko’s proposal, if the medical bill is $1,000 or more, patients would be able to request arbitration to try to sort it out. Insurers and medical providers would be required to take part in that process.
But Arizona Sen. Nancy Barto, during that same vote, said this measure would not solve the problem.
"This bill would only apply to a tiny segment of the market, with PPO plans," Barto said. "Not self-funded plans, not HMOs, not AHCCCS, not Medicare."
Texas and California are also dealing with this issue.
Stacey Pogue is senior policy analyst with the Center for Public Policy Priorities in Texas.
Tam Ma is the Legal and Policy director at Health Access California, which is a state health-care consumer-advocacy coalition.
Arizona’s bill dealing with surprise medical bills, SB 1441, is awaiting debate in the House; it’s already cleared the state Senate.