Adam Fox, The Denver Post

Health care costs are high — that’s no surprise.

Most elected officials have promised to address that kitchen-table concern. But the big question in Colorado this legislative session is, will the General Assembly deliver?

While there are a lot of good proposals in the works, one quick and straightforward way to address the costs facing consumers and the health care system as a whole is to finally put an end to surprise out-of-network bills.

These bills are generated when someone is treated at an in-network health care facility but is treated by a doctor that is, in fact, not part of their insurance network or when a consumer has a medical emergency and is treated at an out-of-network hospital.

Weeks after receiving care, consumers are hit with “surprise bills.”

Colorado has grappled with this issue for years now, with various attempts in the legislature thwarted due to politics and, well … profits. Some, like U.S. Sen. Michael Bennet, are working on this issue federally, but Colorado legislators need to tackle this issue now.

In these surprise bills, both providers and facilities are guilty of charging exorbitant costs — much higher than the typical in-network rates. Consumers are on the hook, either for paying those bills out-of-pocket or through higher insurance premiums.

And, unfortunately, these surprise out-of-network bills are becoming increasingly common. Roughly 30 percent of the calls that the Colorado Consumer Health Initiative receives through our Consumer Assistance Program are because of these surprise bills.

These bills harm people like Juanita, who was hit by a $2,400 bill she shouldn’t have owed from an out-of-network surgeon when her husband needed surgery; and Jen, whose son was seen at an in-network urgent care center for a sore throat and then got a $600 bill from the doctor who she discovered was out-of-network.

Four in 10 Americans can’t afford an unexpected $400 expense, so these surprise bills can throw many people into a financial tailspin. Some medical providers have gone so far as to send Coloradans to collections or have liens put on their homes even when the insurer, not the consumer, should have been responsible for paying the bill, as seen in recent 9News coverage.

These predatory practices don’t just hurt the individuals that are treated, they hurt all of us. In cases of emergencies, an out-of-network facility can charge your insurance company whatever they want, almost like picking a number out of a hat.

When they do, they sometimes charge as much as 385 times what Medicare pays for the same services. (Yes, you read that right, not 385 percent … 385 times or 38,500 percent.) When Medicare would pay $510, Colorado doctors wanted more than $200,000. In emergency situations, insurers have to cover these services regardless of cost. Believe me, I’m not bringing this up for the insurers’ sake, but because insurers end up passing those outrageous charges onto consumers, like you, in the form of higher premiums.

It’s no surprise, it’s time for Colorado legislators to fix this. And the solution needs to be bold enough to protect consumers and control these unnecessarily high charges.

See the original article here. 

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