New Law Proposal by IN Senator Mark Messmer of Jasper Hopes to Make Medical Billing More Transparent as of July 1st

Indiana (NNDC):

Limits to surprise medical billing start July 1

By State Sen. Mark Messmer (R-Jasper)

To help improve health care costs for Hoosiers, the General Assembly passed several measures during the 2020 session, including House Enrolled Act 1004.

This new law, which goes into effect on July 1, limits “surprise billing” for medical services by requiring doctors, hospitals and insurers to give a patient a good faith estimate of the cost of non-emergency procedures even if the patient does not request it.

Surprise billing occurs when a patient goes to the hospital or other facility that is in-network for their insurance plan, but at least one practitioner who treats them at the facility is out of their network. In this situation, the patient will receive an out-of-network bill that  they likely did not see coming.

This situation arises because facilities use independent practitioners to perform services on their premises. While the facility’s employees are in the patient’s network, the independent practitioners may not be.

HEA 1004 protects Hoosiers from being surprise billed without resorting to a heavy-handed government rate setting. Under this law, doctors may still charge their normal prices as long as they notify patients ahead of time and the patients consent. However, if the doctor and patient don’t agree in advance, then the patient cannot be made to pay a surprise bill beyond what their insurance plan covers.

In addition, HEA 1004 does not apply to emergency services. Requiring a patient to sign a good faith estimate in advance would become an unnecessary hurdle in getting them urgent, life-saving emergency care.

With more than 12% of in-network hospital admissions in Indiana resulting in an out-of-network surprise bill, this is an important step for our state. Health care is a complex issue and can be overwhelming for many. I’m very pleased to see this practical legislation come into law, helping lift a common financial burden for many Hoosiers

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