There’s news of an important potential breakthrough on an issue that is important to hard-working middle-class Oklahomans, even if they aren’t aware of it.
So-called surprise medical billing can be a devastating financial hit to people who work hard and play life by the rules.
Here’s the scenario: A fully insured person goes to the hospital for treatment. The patient checks in advance to make sure that the hospital is in-network and the procedure should be eligible for maximum coverage.
But later, after it’s too late to do anything about it, the patient discovers — when the bill arrives — that somewhere in the process the network’s borders were crossed. Whether in treatment or testing, some provider wasn’t covered.
Here’s your bill. Surprise!
It happens a lot. A 2016 Health Care Cost Institute study of 620,000 insurance claims nationally found that 14% of Oklahoma in-network admissions resulted in out-of-network professional claims. Out-of-network charges most commonly came from independent labs and emergency medical treatment, according to the study.
Legislators, hospitals, insurance companies and other interested parties have been negotiating for a way to fix the system, and three lawmakers announced earlier this week that there has been a breakthrough.
In a press release, state Reps. Marcus McEntire, Chris Sneed and Tammy Townley said the negotiations have led to an agreement that will prohibit surprise billing and hold insured patients harmless. The lawmakers promise legislation early in the session this year to resolve the issue.
If that turns out to be true, it would be great.
We’re anxious to see the details, as should be thousands of Oklahomans who may some day need to go to the hospital. Sometimes it’s not wrong to negotiate behind closed doors, but to check for the public’s interest, especially in an issue as critical as this to so many people, the deal needs to be vetted fully to make sure it does what it promises to do.
If this is the state’s best opportunity to address the issue, let’s make sure we do it right.
We don’t want any more surprises.