NC Senate approves legislation to prevent ‘surprise billing,’ lower health care costs

·4 min read

North Carolina’s Senate nearly unanimously passed three health care bills this week that advocates say could clear major roadblocks to lower costs for consumers and improve access to care in the state.

One of those bills would address the issue of “surprise” medical billing by requiring that in-network health care facilities and hospitals notify patients in advance if an out-of-network provider will care for them and how much that care might cost.

The issue garnered support in Congress last year at a time when hospitals have increasingly turned to third-party staffing firms, which can place more out-of-network providers in emergency rooms or local hospitals. Those private staffing firms could inflate health care costs in an area by 66%, one federal report found.

In previous years, similar but broader legislation received little support in North Carolina’s legislature. This year, though, sponsors opted to simplify the proposal in hopes that it will face less opposition from fellow lawmakers.

“How you can be against that?” said Austin Vevurka, executive director of the North Carolina Coalition for Fiscal Health, which works to mitigate what it calls “costly, burdensome economic and health care policy” and is closely tied to Blue Cross Blue Shield. “How can someone oppose giving patients information?”

Groups representing physicians and hospitals oppose the legislation, saying they support protecting consumers but argue the bill would increase financial challenges for providers and harm access to care.

And while Senate Bill 505 passed the Senate with little debate and unanimous support, moving the bill through the House may present a challenge. The Senate tends to agree with insurance companies on legislation, and the House is usually more likely to side with health care providers, as there are numerous nurses, a pharmacist and a physician.

Senators expect that this year’s version of the bill will have a better shot at passing the House because it does not include a provision that sets benchmark payment amounts for out-of-network care.

In Washington, Congress passed some protections for consumers against surprise billing late last year, but facing pressure from powerful lobbying groups including third-party staffing firms, lawmakers stopped short of passing a ban on unexpected medical bills altogether.

If North Carolina’s legislation passes the House and is signed by Gov. Roy Cooper, health care facilities would, when possible, be required to give patients written, 72-hour notice that they’ll be cared for by an out-of-network provider. When that’s not possible, providers would have to notify patients the day of a procedure, or as soon as possible in emergencies.

Patients deserve to know those costs up front, Vevurka said, rather than receive a bill for thousands of dollars months after the fact.

Groups representing physicians, though, said the federal legislation did enough to address surprise billing issues.

Some two-thirds of adults received an unexpected medical bill in the previous two years, a February 2020 Kaiser Family Foundation poll found.

The Senate also passed two other health care bills, including one that would streamline the process for health care providers and facilities seeking government approval for new equipment or services. Supporters say another provision in the legislation would increase competition among health care facilities and expand access to care.

Another bill heading to the House would let small businesses offer exclusive provider benefit plans. Similar laws have been implemented in dozens of other states.

Vevurka said because of the passage of the three bills, Wednesday will likely go down as one of the biggest pro-consumer, health care reform days at North Carolina’s General Assembly.

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