Consumers to know their rights when receiving unexpected medical bills
DENVER – There’s hope for bipartisanship yet. The state’s leading advocate for healthcare consumers, the Colorado Consumer Health Initiative (CCHI), has high hopes for the passage of legislation that will provide information and explain potential legal protections to Coloradans caught off guard by exorbitant “balance bills” in health care.
Surprise, out-of-network bills arise when consumers seek services at an in-network facility but unknowingly are seen by an out-of-network provider or are treated at an out-of-network facility in an emergency.
Yesterday, Senator Bob Gardner (R) and Representative Daneya Esgar (D) introduced Senate Bill 237, legislation to require that healthcare providers, facilities, and carriers notify consumers in plain language about their rights regarding these surprise medical bills.
“My family member was hit by balance bills of $3,000 from out-of-network providers even though he was seen at an in-network hospital,” said Chuck Woodard of Arvada. “There was no disclosure by either the hospital or the doctors that my family member was being treated by out-of-network doctors. Nor was there any explanation by either the hospital or the doctors of his rights and responsibilities under Colorado law. We need much, much better disclosure than we have now.”
The proposed legislation, SB 237, would require new rules for correspondence and billing after a medical procedure to clarify that an out-of-network provider was part of treatment and that consumers may have certain protections against balance bills. Under current law, Coloradans with insurance plans regulated at the state level are to be held harmless and pay only what they would owe for in-network care when they are unknowingly treated by an out-of-network provider. However, there is nothing in Colorado law that requires consumers be notified of these rights, and consumers often end up paying bills they don’t legally owe.
“Notice and disclosure are key for keeping the consumer from being caught in the middle of billing issues between insurers and healthcare providers,” said Adam Fox, Director of Strategic Engagement of CCHI. “Caught in this spot, with basic information withheld by the provider, consumers are vulnerable, can be sent to collections, and pay much more than they actually owe. We just want to see consumers armed with information about their rights in transparent billing practices by providers and carriers.”
The bill has been assigned to the Senate Health and Human Services Committee for its first hearing.
Colorado Consumer Health Initiative represents 45+ Colorado health organizations with more than 500,000 health care consumer members advocating for high-quality, affordable, and equitable health care for all Coloradans.