Ohio Senators Push Measure to End Surprise Medical Bills, Improve Price Transparency

Published July 26, 2019

As of mid-July, the state was operating on a temporary budget extension after having missed the July 1 deadline to pass a budget. 

Shopping Around

One provision would require health care providers to provide cost estimates for service within seven days when asked, says Ohio state Sen. Matt Dolan (R-Chagrin Falls).

“Right now, people often don’t ask about price,” said Dolan. “Let’s say a doctor orders a blood test and tells the patient, ‘Let’s go down to the lab.’ Now the consumer can ask, ‘How much does it cost?’ They can then compare the price of the blood tests to the prices offered by other providers. Maybe an independent lab down the street is cheaper.”

The proposed budget provision would also encourage patients to make smarter health care decisions, says Dolan.

“Patients can ask themselves, ‘If it’s not a true emergency, should I avoid the emergency room?’ Or, ‘If I go to a free-standing emergency room instead of the hospital, is it cheaper?'” said Dolan.

Price transparency is always beneficial to consumers, says Devon Herrick, a health care economist and policy advisor to The Heartland Institute, which publishes Health Care News.

“Price transparency will hopefully give patients time to ask questions and seek care from more-competitive providers,” Herrick said. “Consumers need price information in ways they can use it to make informed decisions.”

Banning Balance Billing

The Senate and the House versions of the budget alike would ban “balance billing,” under some conditions, in which patients are charged for the difference between what the provider charges and what the insurance company allows.

Balance billing often results in surprise medical bills. Many patients find themselves stuck with big bills for the cost of out-of-network treatment, through no fault of their own, Dolan said. The Senate ban would apply to unanticipated situations unconditionally and to other circumstances under conditions listed by the House bill.

“Surprise medical billing occurs when a hospital or facility brings in an out-of-network practitioner without the patient’s knowledge or consent,” Dolan said.

“It is no fault of the patient that the doctor was out of network, but in many cases, they are billed for the [extra] cost,” said Dolan. “The burden should not be on the patient. It should be on the facility that utilized an out-of-network practitioner. The patient should only pay in-network costs.”

Taking Advantage

Surprise medical bills are a result of a health care system made dysfunctional by decades of government intrusion and in which consumers are often abstracted from the true costs and providers therefore don’t compete on price, Herrick says.

“Surprise medical bills derive from those ancillary hospital providers, whom patients do not choose or meet prior to care,” Herrick said. “Some providers take advantage of the opportunity to bill patients for fees far higher than would be charged in a competitive market where consumers have the opportunity to compare prices.”

One solution is to require health plans to pay ancillary physicians a standard fee, Herrick said.

“Then physicians can negotiate additional compensation with their hospital sponsors, if the market warrants it,” Herrick said.

Ashley Herzog ([email protected]) writes from Avon Lake, Ohio.