House OKs bill to prohibit surprise medical bills

Published 9:11 am Friday, April 14, 2017

The Oregon House approved a measure Tuesday that would prohibit surprise medical bills.

Representatives voted 36-22 in favor of the measure, which prohibits health care providers from charging higher, out-of-network prices for services rendered at in-network facilities. With one exception, the vote fell almost entirely along party lines, with Republicans voting against the measure and Democrats in favor. House Bill 2339 now moves to the Senate for consideration.

The measure would protect patients from getting expensive bills from providers, such as anesthesiologists or surgeons, who don’t contract with their insurance carrier, but who treated them at an in-network facility, usually a hospital. Patients are typically unable to determine ahead of time whether their insurer contracts with every provider who will treat them during a hospital stay, especially in emergency situations.

While everyone who spoke about the bill during its debate in the House agreed surprise medical bills — commonly referred to as balance billing — are a problem, there was significant disagreement over how much out-of-network medical providers should be paid for their services.

Groups representing emergency physicians and anesthesiologists oppose the measure.

They told lawmakers the measure would force doctors to accept lower reimbursement for their services, and warned it could cause some doctors to leave the state.

Bend Rep. Knute Buehler, was among the Republicans who voted against the measure. Buehler, an orthopedic surgeon with The Center Orthopedic & Neurosurgical Care & Research in Bend, said while he opposes surprise billing, he disagrees with how this measure would calculate how much doctors would get paid.

The measure would price nonemergency services at a percentage of Medicare rates. Emergency services would be priced based at whatever is highest: in-network, out-of-network or Medicare rates.

Buehler said he opposes using Medicare rates, which he said are politicized numbers that don’t reflect the true cost of providing care.

“The price is now set so low that it gives unfair advantage to the insurance companies because it forces providers to sign a lower contract than if they were in-network and signed the contract they were offered by the insurer,” he said.

A number of health insurance carriers support the measure, including Providence Health Plan and Cambia Health Solutions, the parent company of Regence BlueCross BlueShield of Oregon and BridgeSpan Health.

The consumer advocacy group OSPIRG supports the measure. Jesse Ellis O’Brien, the group’s policy director, said the lack of transparency around health care pricing makes it difficult to determine an appropriate reimbursement rate.

“I actually think that it is appropriate for providers who are out of network to be get getting a lower reimbursement rate than those in-network,” he said, “because if they’re getting a higher rate, then it would actually be an incentive for providers not to contract, and then you just kind of multiply the problem.”

So long as a patient’s insurance carrier contracts with St. Charles Health System, insurers typically pay doctors who treat patients at St. Charles Bend their in-network rates, even if they don’t contract directly with the doctors, who are employed by Central Oregon Emergency Physicians, Dr. Gillian Salton, an emergency physician with the practice, told The Bulletin in February.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com