I am so excited to let y’all know that the OR legislature has passed a VERY IMPORTANT piece of legislation to protect the consumer in the event of Emergency Care and planned care at in network facility.
It has been a huge issue for many years for Consumers who receive care in the ER for urgent and Emergency Situations and they are treated by non-network providers. There are many Trauma Physicians who do not contract with Health Plans.
The non-network providers would balance bill the member amounts above and beyond the allowed amount of an in network provider and it could be into the hundreds and thousands of dollars.
The member-patient has no control who is treating at the ER and it was very unfair if the Member-Patient went to in network facility for care and being balanced billed for care in which they had no control over who is providing care.
The legislation also protects Members-Patients from being balanced billed by providers for planned medical care such as surgeries , if they are using an in network facility and procedure has been prior authorized
This is particularly an issue with Anesthesiology , many anesthesiologists do not contact with health plans , and they will balance bill into the hundreds or thousands of dollars. In majority of cases you cannot control who administers anesthesia and not fair to balance bill for services you cannot control.
Out of network providers may balance bill if the member chooses to use an out of network provider or facility.
Details are below
This is a landmark piece of legislation for Consumer protection and I am personally thrilled it finally passed! I have lobbied legislators regarding this for years, and finally passed.
On 3/1/18, the Oregon Department of Consumer and Business Services (DCBS) issued the following media release:
New law protects consumers from surprise medical bills
Salem — Beginning March 1, a new law protects consumers from receiving surprise out-of-network medical bills from health care providers. The new law prevents health providers, who were not chosen by the consumer, from balance billing services performed on or after March 1, 2018.
Balance billing occurs when an out-of-network health care provider you did not choose, such as an emergency room physician, anesthesiologist or radiologist, bills you for more than the allowed in-network charges for the following:
An emergency service at any medical facility
Part of a planned procedure at an in-network facility
The Division of Financial Regulation is available to assist Oregonians who believe they have been improperly balance billed.
“It is almost impossible to choose every medical provider at a medical center that treats you, even more so in the case of an emergency,” said Andrew Stolfi, Oregon insurance commissioner. “If you are surprised by a bill from an out-of-network doctor or other health care provider, you should connect with our advocacy team immediately.”
Additionally, the law requires health care providers to inform consumers about the increased financial responsibility when choosing services from an out-of-network provider.
If you receive services from an out-of-network provider, you may still be responsible for co-insurance, co-payments, or deductibles. The new law does not prevent consumers from choosing an out-of-network provider, nor does it prevent out-of-network providers from balance billing consumers when consumers choose to see them.
If you have questions or concerns regarding your insurance coverage or a surprise medical bill connect with our advocates at 888-877-4894 (toll-free) or visit http://dfr.oregon.gov/gethelp/Pages/file-a-complaint.aspx.