State senator expects new insurance regulation

Legislative committee report could see up to three new bills in the new year

Insurance News

By Lyle Adriano

State Sen. Dean Burke, who chaired a legislative study committee that reviewed insurer networks and contracts, revealed that the committee’s work could possibly lead to three new bills for Georgia in 2016.

The committee consisted of medical providers, representatives of an insurance company, and a consumer group.  The panel finished its work on December 14, voting unanimously to approve a report on its findings.

Several industry concerns were tackled by the panel, including: the issue of medical provider networks with a severely limited choice of doctors; insurance companies using outdated directories of healthcare providers; consumers being charged exorbitant fees when they received treatment from a healthcare provider that is not in their insurers’ networks; forcing doctors to participate in all of an insurer’s health plans; small practices having little influence in contract negotiations with health networks; and health plans using discounted fees for paying doctors, leaving the healthcare providers with even less to reimburse.

The committee’s findings follow the National Association of Insurance Commissioners’ (NAIC) recent recommendations for new standards that seek to increase the accessibility to doctors and hospitals in health plans associated with the ACA.

NAIC’s recommendations also include requiring insurers to have enough healthcare providers and hospitals in their networks to provide all covered services to their customers without inconveniencing consumers in any way.

“Consumers need clearer standards, and a better ability to navigate in the new world,’’ appealed Cindy Zeldin, a representative of the consumer group Georgians for a Healthy Future, to the study panel before it made its vote.

“Providers in this state are highly disadvantaged,’’ added John Crew of Strategic Healthcare Partners.  “We do need legislation. We’re faced with consolidation in this state. This issue will grow exponentially.”

Further action on the issue of balance billing was suggested at the end of the panel. Balance billing is when a non-network healthcare provider bills a patient even after the patient’s insurer has paid its share, forcing the patient to pay for high out-of-network prices.
 

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