| G. Michael Dobbs
SPRINGFIELD - State Sen. James Welch isn’t going to give up on a bill that could help solve a recurring problem in healthcare: the surprise bill consumers receive when they use a medical service out of their insurance network.
Welch’s bill had been part of this year’s state budget as an outside section, but was removed by the conference committee as part of the final part the Legislature approved.
His legislation would have required patients to be notified they are using a medical supplier that is not covered by their insurance and there would be pre-determined rates to pay for the service.
Welch told Reminder Publications he has heard “horror stories” from hundred of people about being surprised by a large bill because they had unknowingly used the services of a doctor who is not in their insurance network.
“It happens, unfortunately, quite often,” he said. Medical personnel are asked to substitute for each other quite frequently and those replacements may not be part of the same insurance network, Welch explained.
The proposed legislation came out of the Provider Price Variation Commission of which Welch is the co-chair. He said the commission is made up of 23 “high level” health industry officials.
The legislation had “universal support to address it immediately,” Welch described, but something went wrong in the conference committee. He had not been told a reason.
He theorized the financial impact of the legislation on medical personnel might be part of the answer. The bill would have set a default rate for procedures, which would have been less than what is now charged. If the bill had become law, physicians would not have been able to charge as much.
Another part of the bill would have added greater transparency to another medical industry practice - different rates for different facilities. Welch said consumers might not be aware that having a procedure at one building that is part of a medical center, but is not the main building, can change the rate of the service. The bill would requite health providers to explain up front how the venue could change the cost of a procedure.
Both aspects of the bill were designed to give people greater involvement and control over their own healthcare, Welch said.
He added that making changes to healthcare policy is “difficult.”
Welch said, “This [bill] should have been an easy fix. This is low hanging fruit.”
Right now the Legislature is working on changes in Mass Health proposed by Gov. Charlie Baker and the Senate is planning to address cost containment legislation, Welch explained. His bill should be part of the new legislation.
“It should be easy,” Welch said, “but you never know until it’s signed into law.”