There’s a bill in the North Carolina Legislature that seeks to eliminate some surprise medical billing, among other things. Here’s a real-world example from Cumberland County:

Yours truly found himself with an exceptionally bad intestinal bug a few years ago. I then found myself in the Cape Fear Valley Hoke Emergency Room. I figured Hoke would have a shorter line. After I was admitted, a staff member rolled a fancy computer with a credit card scanner beside my bed. She took my insurance info and showed me what me what it would cost out-of-pocket. I paid before anyone would see me. It wasn’t cheap. They gave me IV fluids and ran some labs.

A few weeks later, I got a bill from the lab technician for several hundred dollars. I called Cape Fear and told them I already paid for everything. Cape Fear’s response was that their lab was “in-network” but the person who actually worked in the lab was not. He was special, apparently.

I was pretty upset, but I paid it anyways.

I think a lot of people do.

Most of you have probably faced the maze of medical billing at some point in your life. It’s insane. I deal with it every day in my legal practice, and I’m often frustrated by the amount of waste and deception that is involved. This provision is a step in the right direction:

All contracts or agreements for participation as an in-network health service facility between an insurer offering health benefit plans in this State and a health service facility at which there are out-of-network providers who may be part of the provision of services to an insured while receiving care at the health service facility shall require that the in-network health service facility give at least 72 hours’ advanced written notification to an insured that has scheduled an appointment at that health service facility of the provision of any services by an out-of-network provider to the insured while at that health service facility. If there are not at least 72 hours between the scheduling of the appointment and the appointment, then the in-network health service facility is required to give written notice to the insured on the day the appointment is scheduled. In the case of emergency services, the health service facility is required to give written notice to the insured as soon as reasonably possible. The written notice required by this subsection shall include all of the following:

(1) All of the health care providers that will be rendering services to the insured that are not participating as in-network health care providers in the applicable insurer’s network.
(2) The estimated cost to the insured of the services being rendered by the out-of-network providers identified in subdivision (1) of this subsection.

Click to access H149v3.pdf

Doctors Oppose Patient Protections

The North Carolina Medical Society, a special interest group representing physicians, opposes this reform. Per Paul Woolverton at the Fayetteville Observer:

The Medical Society has concerns about this provision, Baggett said.

“We’d like to see an end to surprise billing also,” he said, but doctors worry that when they see the cost, some patients may forgo care that they need. The Society wants to work with the legislature to find another solution to surprise billing, he said.

https://www.fayobserver.com/story/news/2022/06/01/medicaid-expansion-healthcare-north-carolina-medicaid-con-certificate-of-need/9914529002/

The arrogance of physicians (and their lobbyists) in this case is baffling.

When people can’t afford the cost of a service, they don’t usually ask for it. You don’t get to trick them into accepting your service by hiding the cost up front. In any other instance in our society, we would simply call this “fraud.”

Apparently, the physicians and their lobbyists prefer the current way we do things: don’t tell people what it’s going to cost and send them a bill later. If they don’t pay it, send them to collections and wreck their credit score.

It’s awful, and it ruins people’s faith in our health care system.

Fix it.