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Lawmakers Consider Eliminating Surprise Medical Billing


Monday, March 4, 2019   

DENVER – A new bill making its way through the Colorado General Assembly would protect consumers from surprise out-of-network bills in situations where they either didn't know they were being sent out of network or didn't have a choice.

The law would have helped Zoe Williams.

Two years after her child was transferred to Denver Health Medical Center for a broken leg, Williams was summoned to court for more than $15,000 in medical bills she thought her insurance company already had paid.

"There's no way that we could come up with that amount of money, and we also knew what the impact would be if we were to have a judgment entered against us,” she relates. “And it just didn't seem like it could be possibly fair to do that to people."

Under current law, health care providers are supposed to negotiate out-of-network payments with state regulated insurance companies. But providers can, and do, bill consumers directly and often take them to court if they don't pay.

House Bill 1174 would require providers to inform consumers about their rights, and would cap pay rates for out-of-network services.

Critics of the measure argue that providers should be compensated at higher than in-network rates.

Caitlin Westerson, director of legislative affairs for Colorado Consumer Health Initiative, says current regulations are failing people who do their best to get care from in-network providers only to be hit with a bill much higher than what their insurance company agreed to pay.

"If you owe 20 percent for emergency services, you're thinking that that 20 percent is going to be based on the in-network rate,” she points out. “And if that rate then is suddenly as high as the doctor wants it to be, then 20 percent of that can be quite a lot."

As a law student with a background in community organizing, Williams says she was well positioned to stand up for her rights, and she eventually won. She says most people can't afford to spend six hours on the phone for months on end.

"Because it was a pretty epic fight just to get this issue fixed,” she relates. “And I think there are a lot of consumers that don't know that they have that option, or don't have the energy to fight it."

HB 1174 is expected to be heard this week in the House Health and Insurance Committee.

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