STATE HOUSE — Rep. Deborah Ruggiero has introduced legislation to prevent patients from receiving unexpected and very high bills from out-of-network medical providers.
The legislation (2020-H 7127) limits providers in emergency rooms to charging the in-network rate to insured patients, and also requires that hospitals notify a patient in advance if any nonemergency service is going to be provided to them by an out-of-network provider.
The bill is meant to address the issue of “surprise bills,” sent to patients who visit the ER, where they have little choice about their provider, or who visited in-network facilities only to later learn that an individual provider who tended to them does not participate in their network.
“When your child has a serious injury, you don’t stop to ask if the ER doctor is in your network. You just say ‘help my child immediately.’ If the doctor is not in your network, that shouldn’t mean you are on the hook for thousands, or even tens of thousands of dollars, when it would have been a manageable amount from an in-network provider,” said Representative Ruggiero (D-Dist. 74, Jamestown, Middletown) in a statement. “Surprise medical bills can bankrupt families and individuals, and Rhode Islanders deserve basic protections from them. We should not ask people to choose between death and bankruptcy.”
Insurers generally make it the patients’ responsibility to ensure they receive their care from an in-network provider, but often the patient has very little choice about the matter, such as in emergencies. Sometimes the rate charged by an out-of-network provider can be many times the in-network rate, and the patient can be left to pay the difference.
Under the legislation, health care facilities would be required to provide prior written notice of all charges to every patient undergoing nonemergency or elective care, including any services to be provided by an out-of-network provider. Failure to do so would mean the facility would be legally limited to accepting the rate provided by the patient’s insurance.
It would also require Rhode Island facilities to accept in-network rates for insured patients for all emergency services, as well as in-network rates of cost-sharing for the patient.
Surprise medical bills are common. A study by the Peterson Center on Healthcare and the Kaiser Family Foundation found that for people in large employer plans, 18 percent of all emergency visits and 16 percent of in-network hospital stays in 2017 resulted in at least one out-of-network charge.
The legislation, introduced Jan. 16, is cosponsored by Rep. Robert E. Craven (D-Dist. 32, North Kingstown), Rep. Christopher R. Blazejewski (D-Dist. 2, Providence), Rep. Alex D. Marszalkowski (D-Dist. 52, Cumberland) and Rep. Evan P. Shanley (D-Dist. 24, Warwick). It has been assigned to the House Committee on Health, Education and Welfare.