Surprise billing rating system set to start in Georgia

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Health insurance providers in Georgia will be rated on their risk of sending patients unexpected medical bills starting Sunday.

The Surprise Bill Transparency Act, which goes into effect Sunday, requires the Office of Insurance and Safety Fire Commissioner to create an online surprise billing rating database. Every health plan would be given marks based on the chances of receiving an unexpected bill for seeing a select list of specialists.

It is one of two surprise billing measures signed into law in July by Gov. Brian Kemp.

Surprise bills often result from emergency room or urgent care visits when patients go to facilities that are covered by their insurance plans but are treated by a physician or medical professional who is not within the insurer’s network.

The insurance company could opt out of paying for the services, and patients could end up being billed by the provider, oftentimes weeks later. An average of 13% of emergency room visits in Georgia in 2017 resulted in at least one out-of-network charge, Kaiser Foundation researchers found.

Georgia’s rating system would be based on the availability of hospital-based anesthesiologists, pathologists, radiologists or emergency physicians under each health plan.

In a recent study, health policy researchers at the Brookings Institution found about 12% of health care insurance costs originate from surprise bills that stem from hospital-based specialists, emergency facilities and emergency ground ambulance services.

In the rating system, plans can receive up to four green checkmarks or four red Xs. The health plan would receive a green checkmark if a particular specialist is available within the plan’s network. Red Xs would be pinned to plans that do not have those specialists available. The plans’ status would be updated every 30 days.

Brookings Institution found that years of limited regulation of surprise billing has increased health care costs for everyone, not only for patients who received the unexpected bills. In its September study, Brookings found surprise billing policies could reduce health insurance premiums by 1% to 5%.

As of Sept. 16, 31 states have passed surprise billing reforms, according to the Commonwealth Fund.

Kemp also signed the Surprise Billing Consumer Protection Act, which stops patients from being charged for out-of-network health care services. It goes into effect Jan. 1, 2021.

“This is an historic step forward for Georgia when it comes to health care, and, frankly, it couldn’t come at a better time as our state and country face the greatest public health challenge we have seen in the 21st Century,” Kemp said in July.

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