The Senate Health and Human Services Committee heard testimony on a proposal to halt these medical bills, which can come from ER doctors, anesthesiologists, radiologists, pathologists and others who are not in a patient’s insurance network — even though the hospital where they work is.

Vicki Willard, wife of Rep. Wendell Willard, a Sandy Springs Republican, testified that in August, she went to Emory Saint Joseph’s Hospital after experiencing numbness in her cheek and arm.

She knew St. Joseph’s was in her insurance network. “I’m an educated advocate for my health care,’’ she told the panel.

But four weeks after her treatment there, Willard said, she received an unexpected $700 bill from a cardiologist.

She then called her insurer. The first cardiologist who had seen her, she found out, was a network doctor. But a second cardiologist —Ìýthe one who sent her the bill —Ìýwasn’t in her network, even though that doctor was in the same medical group as the other doctor.

“I have absolutely no control over that,’’ Willard said. “That’s extremely frustrating.”

Sen. Renee Unterman (R-Buford), a nurse who chairs the panel and sponsor of Senate Bill 8, said health insurers and medical providers can’t agree on a solution to the “complicated issue.’’

“It’s like putting cats and dogs in a room,’’ she said. “The one that suffers the most is the consumer.”

Beth Stephens of Georgia Watch, a consumer watchdog organization, said issues with medical bills were the No. 1 reason why consumers called her organization in 2016.

The two current proposals on surprise billing — Unterman’s in the Senate and one in the House — call for greater transparency about which doctors are in an insurer’s network and an estimated cost of the procedure.

The Unterman proposal would also create a database of reasonable charges for a procedure. If a bill is disputed, the insurer and doctor would have to work out a resolution.

“I have tried my best to be fair,’’ said Unterman. “To listen to both sides.”

Representatives from the insurance industry said that one database of rates that Unterman’s bill would use, Fair Health, should not be used as a benchmark for reimbursements because it’s too high.

Physician organizations have said they support Fair Health, and blamed “narrow’’ insurance networks for many instances of high non-network charges.

Hospital groups, meanwhile, said the transparency required to educate patients about network providers should be shared among hospitals, physicians and insurers.

Other states, including Florida, recently passed legislation to address the problem.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

President-elect Donald Trump and Rep. Tom Price, the Georgia congressman picked by Trump to lead the Department of Health and Human Services, have backed the proposal. They and other advocates see it as a way to boost competition. The interstate sales idea is part of a general GOP blueprint to replace the 2010 Affordable Care Act, often called Obamacare.

In Georgia, the interstate sale of health insurance has already had a five-year tryout.

The state legislature in 2011 passed a bill letting insurers sell any policies in Georgia that they offer in other states. The legislation was hailed by supporters and business groups as a way to skirt the state’s required benefit coverages —Ìýsuch as screenings for cervical, prostate and colorectal cancer, along with mammograms — and thus lower the sticker price of insurance.

The law is still in effect. But since it was passed, no health insurer has taken advantage of it.

And since January, an obscure provision of the ACA has been in effect, letting individual states agree among themselves to allow sales by one another’s health insurance companies. Although several states have passed laws to move toward such a compact, none has made any deals to sell across state lines, insurance experts and regulators told .

Each state has its own set of health insurance regulations, though large employers that self-insure (those that use their own funds to cover employees’ health expenses) are exempt from these state rules.

Currently, the idea of eliminating barriers to interstate sales is drawing some opposition from state insurance regulators and insurance industry officials, last week. “That sounds like a silver bullet to solve a major problem, and there are no silver bullets,” said Louisiana Insurance Commissioner Jim Donelon. “There are no simple answers.”

Some Democrats have about the erosion of state consumer protections.

Graham Thompson, executive director of the Georgia Association of Health Plans, an industry group, said Wednesday that the GOP proposals aimed at helping health insurers are “a positive change in tune’’ after industry losses suffered under the Affordable Care Act.

A federal law allowing interstate sales across the country “could be different’’ from the more limited Georgia experience, Thompson said. “We’ll have to see the details.”

He said that one obstacle to insurers selling out-of-state policies in Georgia is that “all health care is local —Ìýand all health care costs are local.” So insurers would still have to strike contracts with local hospitals and other medical providers, Thompson noted.

Bill Custer, a health insurance expert at Georgia State University, said a handful of other states have passed interstate insurance laws similar to Georgia’s, but the effect has been the same.

State insurance regulators told the Journal that in states requiring locally licensed insurers to offer extensive coverage, healthy people might abandon those companies to buy bare-bones policies from out of state. That, in turn, would leave local plans insuring mostly people with health problems, who need broader, more expensive coverage. As the locally registered insurance companies absorb the financial hit, the state might feel pressure to relax standards to give them a break.

But the proposals pushed by Price and House Speaker Paul Ryan (R-Wis.) would still require a minimum set of essential benefits at the federal level in order to qualify for tax credits, said Custer of Georgia State. So the effect of interstate insurance could be minimal, he said.

“It’s unlikely to have a large effect on competition in any market,’’ he said.

An industry trade group, America’s Health Insurance Plans, said in a statement to Georgia Health News on Wednesday that “our first interest is in providing consumers with competition and choice, which empowers them to better health and financial stability. We want to work with lawmakers to bring our experience and lessons learned to the table, and we want to cooperate and collaborate to find solutions that work for consumers.’’

Cindy Zeldin, executive director of consumer group Georgians for a Healthy Future, said interstate sales “would erode rights and protections for health care consumers, complicate their efforts to find in-network providers, and do little to nothing to improve affordability.’’

More than 500,000 Georgians are at risk of losing their coverage if the ACA is repealed without an adequate replacement, she said. “Buying a health insurance plan from Texas or Idaho isn’t going to solve the problem, and would leave consumers in Georgia with little recourse if they were treated unfairly by an insurance company based in another state or in cases of fraud.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

That’s costing the hospitals money since patients don’t always turn over the funds, according to the lawsuits, filed by Polk Medical Center in northwest Georgia and Martin Luther King, Jr. Community Hospital in Los Angeles — 2,000 miles apart. Each suit also says some patients have sought to profit from receiving the direct payments for their ER care.

By sending money directly to patients, Polk Medical Center says the insurer forces the hospital to find ways to collect it. Even though patients are obligated to pay the facility the amount sent to them by Blue Cross, in some cases they have spent the money, according to the lawsuit.

The Polk lawsuit said that Blue Cross, in its new payment process, was pursuing “retaliation’’ for the Cedartown, Ga., hospital’s not agreeing to “unreasonable and unfair” terms in order to be part of the insurer’s network. Hospital officials said the payment shift has hurt the hospital financially.

“Blue Cross insures a significant number of individuals in Polk County,’’ said Tommy Manning, the attorney for the Floyd Medical Center system, of which Polk Medical Center is a part.

Manning said that Blue Cross has sent ER payments to patients for several months.

And he said he was unaware of the Los Angeles lawsuit prior to the filing of the Polk complaint.

The lawsuit from Martin Luther King, Jr. Community Hospital alleges that “most of the MLK patients who receive checks from [Blue Cross of Georgia] are unaccustomed to receiving payments in such large amounts. Some of these patients do not know that they are required to endorse those checks over to MLK. Other patients know that they should endorse those checks over to MLK but instead use such funds to pay for their personal expenses. When MLK attempts to collect the amounts from these patients, the money is often spent.”

In the case of patient “B.G.,’’ the suit alleges that the patient went to the MLK emergency room 11 times between Oct. 19 and March 27 for various ailments, including complaints of chest or back pain. Blue Cross of Georgia paid the patient a total of more than $70,000 for these visits to MLK, according to the lawsuit.

The lawsuit said the practice overall has caused MLK to suffer damages in excess of $350,000.

Blue Cross declined comment on the lawsuits, citing pending litigation.

Patients are protected under federal law when seeking care in hospital emergency rooms. Under the Emergency Medical Treatment and Labor Act (EMTALA), they must at least be stabilized and treated, regardless of their insurance status or ability to pay.

Manning said this month that he’s not aware of any other insurer in Georgia paying the patient instead of the hospital.

At least one other major hospital that is not part of the suits has reported difficulty in getting payments from Blue Cross when it was out of the insurer’s network. Officials at Grady Memorial Hospital in Atlanta said that when it was out of Blue Cross’ network for the four months ending in March 2015, the insurer sent reimbursement payments to some patients and not to Grady.

Daron Tooch, a Los Angeles attorney representing MLK Hospital, said other Blue Cross plans in the United States use similar tactics. The Los Angeles patients worked for a company that has Blue Cross of Georgia coverage, he said. MLK is out of network for the Blue Cross plans in California.

“This is not unique to MLK,’’ said Tooch. “This happens to all out-of-network providers for Blue Cross of Georgia.”

Going after the patients for payment instead of the health plan simply hasn’t worked, attorneys for MLK said. The patients “are typically unable or unwilling to pay MLK for the medical services received,” according to the suit.

Manning agreed. “We will continue to pursue collection with patients, but filing numerous lawsuits would not be fruitful, particularly given that Blue Cross Blue Shield is the party ultimately at fault,” he said.

Asked about the Blue Cross of Georgia payment strategy, the national Blue Cross Blue Shield Association, through a spokesman, declined comment. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a trade group, said that those types of reimbursement arrangements would vary by plan and by contract. She added that she did not have details on other plans that may do the same.

Paying patients directly is an insurer tool used more commonly in the West, “particularly when non-network facilities are unwilling to negotiate reimbursement related to out-of-network service,’’ said Janet Guptill of the Tatum firm, which provides interim chief financial officers and other executives to health care organizations.

“The insurer takes the position that the provider claim is a private pay issue between the provider and the patient, so the facility has the responsibility to collect the payment from the patient,’’ Guptill said.

Guptill said that when a hospital isn’t in network, its charges for ER and other care tend to be higher than the charges from facilities in the insurer’s network.

For insurers, paying patients directly is “a clever and probably effective tactic,’’ said Chris Kane, a consultant with DHG Healthcare. The hospital, he said, may already be dealing with other collection challenges, including those involving high-deductible health plans.

A hospital attempting to collect the money may end up alienating the patient and thereby discouraging future visits, Kane said.

And patients pocketing the money is another problem, he added. “It’s more troubling if a patient views this as a source of cash.’’

This story was done in partnership with Georgia Health News.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

GeorgiaÌýGov. Nathan Deal, a Republican, has rejected expansion since he took office in 2011, and GOP lawmakers have repeatedly backed him up. They point to concerns about the future cost of expansion, saying it would eventually put too much strain on the state budget.

But on Friday, Louisiana will become the 31st state — and only the third Southern state — to expand the government program, which is jointly financed by state and federal governments. Gov. John Bel Edwards, a Democrat elected last fall, on his second day in office reversed the course set by his predecessor, Republican Bobby Jindal, by signing an executive order that began the process. Already, have been signed up.

“This isn’t just aboutÌýexpanding health care coverage and saving money,’’ Edwards said earlier this month when addressing reporters at a seminar sponsored by the Kaiser Family Foundation. “We wantÌýhealthier people in Louisiana.” (KHN is an editorially independent program of the foundation.)

And there are small signs of a crack in the opposition to expansion in Georgia.

Georgia state Sen. Renee Unterman (R-Buford), who chairs the Senate Health andÌýHuman Services Committee, recently madeÌýheadlines calling for Georgia to “re-examine’’ the possibility of MedicaidÌýexpansion, perhaps looking at a “waiver’’ plan similar to the Arkansas expansion program.

“We have to open that box and look just aÌýlittle bit and see what’s available,” , the NPR affiliate in Atlanta. “Hopefully, if youÌýdraw down federal dollars, you can free up some of those state dollars. RightÌýnow, we’re just pumping out state dollars to stay in the midst of the crisis.”

A task force created by the Georgia Chamber of Commerce is formulating proposals that would extend coverage to more of the state’s uninsured but not along the lines of a conventional Medicaid expansion.

Yet Georgia state Rep. Sharon Cooper of Marietta, the Republican chairwoman of theÌýGeorgia House’s Health and Human Services Committee, told Modern Healthcare that sheÌýand her colleagues will entertain the proposals, but added that she doesn’tÌýbelieve an expansion plan will solve the problem of access to care.

“The problem with expansion is, ‘Who is going toÌýtreat these people?’ ” Cooper said. “We don’t have the physicians, nurseÌýpractitioners or physician assistants to care for them in rural areas of theÌýstate.”

Since the beginning ofÌý2013, five rural hospitals have closed in Georgia.

A Tale Of Two Southern States

puts Louisiana 50th among states — 10 spots behind Georgia. TheÌýstate has high rates of obesity, hypertension and diabetes, and a highÌýmortality rate from cancer. For Georgia, the rankings note its large number of low-birthweight babies.

Louisiana also has aÌývery high share of people living in poverty, but Georgia has aÌýlarger percentage without health insurance (16 percent).

One key difference betweenÌýGeorgia and Louisiana is the Peach State’s much stronger fiscal situation. Louisiana, where the energy industry is very important,Ìýhas been hit hard by a decline in oil prices.ÌýEdwards inherited what he calls a record state deficit.

But ironically, thatÌýdeficit eased the road for expansion, officials say. “The budget crisis was aÌýcatalyst for the Legislature to come aboard,” said Dr. Rebekah Gee, secretaryÌýof the Louisiana Department of Health.

A study found that theÌýexpansion would produce net savings of $184 million for Louisiana, including in-state money paid to hospitals and moving some current Medicaid patients into aÌýbetter federal matching rate of 95 percent.

Part of Louisiana’s push to enroll new people in MedicaidÌýhas come through a unique mailing to 105,000 food stamp recipients,Ìýlike Aretha Frison, of the New Orleans area, who works at an animal hospital part time and battles depression.

She said she “had been hitting a lot of brick walls” when trying to get psychiatric care but now “it seems like Medicaid is the golden ticket.”

About 180,000 other peopleÌýwere ‘’auto-enrolled’’ from aÌýpreviousÌý“waiver’’ program that did not provide coverageÌýfor hospital services or prescription drugs.

Help For HospitalsÌý

Advocates for Medicaid expansion in Georgia often tout the expected benefits for the state’s hospitals, many of which are financially stressed. Though hospitals inÌýother states have reported substantial revenue gains as a result ofÌýexpansion, Louisiana’s complicated system of funding for hospitals may notÌýyield many clear winners.

Louisiana has had anÌýunusually heavy reliance on ‘’disproportionate share’’ funding, which the stateÌýpays out to those hospitals serving a large number of indigent or uninsuredÌýpatients.

While the giant OchsnerÌýHealth System said Medicaid expansion would be slight improvement for the system financially, BatonÌýRouge-based Our Lady of the Lake Hospital said expansion may bring a payment cut overall with the loss of disproportionate share funds.

But low-incomeÌýresidents should benefit greatly.

More than half of the 4,000 medical patients at the New Orleans CrescentCare health center are expected to qualify for Medicaid under expansion, which may lead to better care options.

For example, Alicia Honomichl, a registered nurse there, said expansionÌýwill help more people obtain PrEP, a medication that can prevent a person from getting HIV from an infected individual, whether through sexual contact or sharing of drug-injection equipment.

Dr. Peter DeBlieux, chief medical officer ofÌýthe brand-new University Medical Center New Orleans, said the Medicaid change isÌý“earth-shattering’’ for his patients.

Patient accessÌýto regular medications will be “low-hanging fruit’’ that will come fromÌýexpansion, and “I expect [cancer] screenings to skyrocket,” he said.

This story was done in partnership with .

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .