Sisolak signs bill to rein in “surprise billing”

Gov. Steve Sisolak signed a bill into law Wednesday that would clamp down on “surprise billing,” a practice that allows out-of-network health care providers to gouge patients in need of emergency care.  

Assembly Bill 469 would limit the amount out-of-network providers can charge in such circumstances to no more than a patient’s insurance co-payment, co-insurance, or deductible. It also establishes a course of action for third party providers to transfer patients to an in-network hospital or independent center for emergency care within 24 hours, and procedures to work out payments between insurers and third-party providers.

If the now-out-of-network provider previously had a contract with the insurer, the legislation also leaves insurers on the hook to pay a percentage of the contracted rate.

“If you’re experiencing a medical emergency, the last thing you’re worried about is making sure the provider treating you at the nearest hospital is in your insurance network. If it’s not, you can be hit with an outrageously high bill for your emergency care without knowing it, even though you have health insurance,” said Sisolak. “No Nevadan should have to worry about getting hit with an unexpected five-figure medical bill for receiving emergency care that their life could depend on,” calling the bill “an important step” in making health care more affordable.

Assemblywoman Maggie Carlton, who was one of the original framers of the AB469, said Democrats have worked on the language of the bill for more than a decade in one form or another. They very nearly succeeded in 2017 when a similar bill made it through the legislature before former Republican Gov. Brian Sandoval vetoed it.

“No one should ever be punished for seeking life-saving care in the event of an emergency,” said Carlton in a statement. “This year, under the leadership of Governor Sisolak, Assembly Speaker Frierson, and Majority Leader Cannizzaro, we finally made it happen.”

Karen Pollitz, a senior fellow at Kaiser Family Foundation, says surprise billing happens more often than people think. Even if they have insurance, certain medical procedures might not be covered.

“An emergency arises, you don’t check to see if you’re in network,” she said.

As one example of the practice, Pollitz described a woman who goes into labor, goes to her pre-selected doctor and hospital, both of whom are in her insurer’s network, but then gets an epidural from a physician who is out of network — and a separate bill that isn’t covered by the mother’s insurance.

Another example: A man who got a post-operation infection and returns to the hospital, which was in-network, for rehab, only to discover the rehab, even though performed at the same hospital, was out of network.

Sisolak also signed legislation Wednesday to improve coverage standards and protect people with pre-existing conditions.

Assembly Bill 170 writes protections for health coverage for pre-existing conditions into state law. This bill also empowers the Office of Consumer Health Assistance within the Department of Health and Human Services to help Nevadans secure appointments for care with in-network providers.

“This means that if the Affordable Care Act is struck down in Washington, Nevadans won’t be denied coverage due to a pre-existing condition. 1.2 million Nevadans are living with pre-existing conditions and could have their coverage ripped away from them and face astronomically high health care costs if the Affordable Care Act is overturned,” said Sisolak.

Democrats have attempted to enact legislation on surprise billing in the past. A nearly identical bill made it through the legislature in 2017 before being vetoed by Sandoval.

“This bill is important because if you can’t get insurance due to a pre-existing condition — or if you cannot get an appointment in a timely manner — you do not have adequate access to health care,” said Assemblywoman Ellen Spiegel, the bill’s primary sponsor. “This law will help address those issues.”

According to the Kaiser Family Foundation, about one in four Americans say they have medical bills they can’t afford to pay.

Pollitz said about 45 percent of people surveyed had bills of less than $2,500, and about 8 percent had bills of more than $10,000.

“These aren’t six figure numbers we are talking about,” she said. However, medical bills still “make it harder to pay other bills. You get behind on rent or car payments. The burden of medical bills leads to other barriers like accessing future health care.”