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From the Alliance

Dr. Eric Freeman: Virginia’s chance to reform ER billing

This article originally appeared in the Roanoke Times

OUR MINDS are a racetrack of speeding thoughts as we ponder serious life decisions.

“How much of my time will this command,” we ask ourselves as thoughts zoom by. “What does it mean for my quality of life?
“How much will it cost me?”

Sometimes, we get a full lap around the track before making a choice. Other times, life happens fast and we don’t get the benefit of careful forethought.

When an unexpected health emergency arises, for example, there isn’t much time to think. Split decisions must be made.

In those times, our minds instinctively know the appropriate response is to seek immediate, life-sustaining medical attention, without thinking of other factors.

The clinicians who care for patients in such urgent situations are likewise singularly-focused – their attention is on the job of responding to the acute needs of the person in front of them.

At that time, neither the patient nor the health care provider is thinking about the person’s health insurance status or what the final bill for medical care will be.

Every so often, an emergency patient who receives crisis care will subsequently discover that the provider who treated them is out-of-network with their insurance company.

That realization for insured patients and their families can coincide with the sticker shock that accompanies the arrival of an unexpected medical bill, sometimes for thousands of dollars.

If a patient’s insurer refuses to pay a portion of the bill because the doctor who treated them isn’t in-network, the patient could be liable for the difference.

This week in Richmond, the General Assembly is considering legislation to remedy those situations in a way that shields patients from a practice referred to as “balance billing.”

One measure in the hopper is House Bill 1714, a patient-centric piece of legislation that has support from doctors, emergency physicians, pediatricians and hospitals.

As proposed, the bill’s provisions offer several layers of patient protection from balance billing that arises from emergency medical situations, including:

  • A condition that limits a patient’s financial liability and exposure when receiving emergency care from an out-of-network health provider;
  • Language making it clear insurers can’t deny claims from insured patients who seek emergency care due to a health scare that ultimately is diagnosed as a non-emergency condition; and
  • The establishment of a standard for insurers to pay fair value for emergency services provided to insured patients who receive health care services from an out-of-network provider.

In the often less time-sensitive world of pediatric primary care, my area of practice, my staff and I have the benefit of informing patients whether they are in-network prior to treatment being rendered so there are no surprises.

Information, education and transparency are vitally important for all health care consumers and patients.

We owe that to the people we treat. As providers, we have an obligation to care for patients, advise them about the benefits of healthy behaviors and habits, and better educate them about the complex and confusing nature of health care insurance coverage and billing.

Unfortunately, that isn’t always possible in emergency situations when time is critical.

Recognizing that situations exist when time doesn’t allow emergency providers to have explanatory conversations with patients in crisis, it is essential for the health care community to support solutions that treat patients fairly and protect them from unanticipated financial fallout attributable to the intricacies and vagaries of commercial insurance.

We have an opportunity to take an important step in that direction this winter by supporting passage of HB 1714 on behalf of the patients we serve. As a physician, I wholeheartedly support this legislation and I hope my colleagues in the medical community will join me in that stance.

Richmond native Dr. Eric B. Freeman, FAAP, is a general pediatrician and the president and physician-in-chief of Old Dominion Pediatrics in North Chesterfield County.

This article originally appeared in the Roanoke Times

The VCHA is a nonpartisan coalition of people working to find common sense solutions to the challenges facing Virginia's health care system in a way that promotes access and affordability.

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