4th try for proposed legislation to protect you from surprise out-of-network medical bills

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After paying $13,000 for a top shelf health insurance plan last year, Jamie Hansen was shocked to discover she was on her own for most of her son's emergency surgery in July.

Hansen, who lives in the Vancouver, Washington area, spent part of Wednesday at the Washington State Capitol in Olympia, to help stop a practice that sticks you with surprise bills for treatment that's out of your control.

House Bill 1065 is more commonly known as the proposed Surprise Medical Billing legislation.

The goal? To stop hospitals and physicians from billing you for out-of-network services when you have no say about your treatment or treatment location.

Hansen is doing her part to support a bill that's been rejected for the past three years.

At this year's first hearing on HB1065, Hansen told the House Health Care and Wellness Committee and chair State Rep. Eileen Cody how her teen son Ryan suddenly got critically ill last summer. She says her regular clinic examined Ryan but he was ultimately referred elsewhere for more specialized testing. A heart infection diagnosis found her being instructed to take her son for emergency surgery at a hospital she knew had doctors who were not in-network.

Hansen said she had no choice. Even though she told the doctors the referred hospital was out of network and the surgery would not be covered, she says she was assured because it was an emergency admission, the surgery would be covered by her insurance.

Hansen was shocked at the hospital bill of more than $112,000. She was even more stunned when her insurance initially paid only $15,000, because most of the doctors were out-of- network.

Under HB 1065, you cannot be billed for out-of- network services if you're fully insured and at an in-network facility or require emergency care.

Instead of making you pay the balance (balance billing) when your insurance company won't pay the full out-of-network charges, the care and insurance providers must negotiate payments among themselves. Any disputes between the parties must go to binding arbitration. The patient cannot be caught in the middle.

Because of her past professional experience in medical benefit clarification, Hansen says she knew how to challenge the bill and negotiate lower charges.

"If I had not been able to negotiate a reduction of this bill and several others, they would have wiped me out," Hansen said. "As it was, I still needed to finance over $38,000 to pay everything off."

The encouraging news is there appears to be no serious opposition to the proposal this year. Hospital, medical and insurance representative say for the most part, they support the bill, it just needs a few tweaks.

Which means HB 1065 (Senate Bill 5031) is far from a done deal. Anything could happen. So if you're dealing with, or have had to deal with, a surprise out-of-network medical bills, now's a good time to speak up. Contact your state legislator or the Office of the Insurance Commissioner, share your story, and make your voice heard.

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