Health care providers in Mississippi continue to break the law by sending patients large, out-of-pocket medical bills that they don’t have to pay, concludes a Harvard Law School report released Monday.
The Legislature passed a law in 2013 to prohibit what is known as “balance billing” – when a provider bills a patient for the difference between the initial charges and the amount paid after insurance benefits are assigned.
But the law contains few enforcement measures, so patients must know about the law and challenge balance bills in order to benefit from the legislation, which was enacted under the radar of many officials and health care providers. Feeble efforts to strengthen protections in the law during the 2019 legislative session were unsuccessful.
Michelle Mills received a balance bill in 2018 when her son experienced a sports injury and went to a hospital in her insurance carrier’s network, River Oaks hospital in Flowood, but was treated by an out-of-network emergency physician.
Across the country, 65 percent of hospitals contract with outside agencies for emergency room doctors who are not necessarily included in the same insurance network as the hospital, according to a 2017 report by Yale University.
The independent physician staffing group called Capital Emergency Physicians, which used River Oaks’ address when it incorporated as a business in 2013, charged Mills $1,853, all but $38 it asked her to pay out-of-pocket. Though it was an illegal bill, she challenged it with her insurance carrier, which reversed the first assignment and paid most of the bill.
Mills was successful in disputing the charges, but she said it’s “infuriating” to think about all the people who don’t know they can challenge these bills, who end up paying, or worse, whose debt turns over to collections.
Capital Emergency Physicians did not return calls to Mississippi Today.
“Unfortunately, our collective trust of the provider community is being abused to the detriment of our bank accounts,” Roy Mitchell, director of Mississippi Health Advocacy Program, said in a release announcing the Harvard report. “It is time our policymakers even the playing field for Mississippi’s health consumers.”
In its report, the Center for Health Law and Policy Innovation of Harvard Law School found that Mississippi’s anti-balance billing law, which was one of the first and strongest enacted in the country, needs revising.
“Despite the state’s leadership on this issue, Mississippians like Michelle Mills report that they are still receiving balance bills — in violation of state law. In fact, a January 2019 poll reported that 4 in 10 Mississippians have received or have a family member who received a surprise medical bill,” the report reads.
House Insurance Chairman Rep. Gary Chism, R-Columbus, authored a bill to require the attorney general’s office to enforce the law and establish binding arbitration to resolve any balance billing disputes between providers and patients.
He never brought the bill to a vote in his committee, telling Mississippi Today that several lawmakers who are also medical professionals — nurses and nurse practitioners — voiced opposition to his bill.
“They want to be able to get their money,” Chism said at the time.
According to a Mississippi Today analysis of legislative members, there is one nurse, Rep. Becky Currie, R-Brookhaven, and one nurse practitioner, Rep. Donnie Scoggin, R-Ellisville, in the House. Currie declined to comment on the legislation and Scoggins said he did not discuss the bill with Chism.
Scoggins said he has not been presented with concerns over illegal balance billing from his constituents, but said if it is still happening, he would be in favor of strengthening the enforcement measures.
The lack of knowledge surrounding the law and what exactly constitutes “balance billing” complicates the issue. What might be viewed as a loophole for a few patients who understand the law could receive pushback from the medical community if lawmakers bring it to light and force providers to comply.
Georgia’s state senate passed anti-balance billing legislation last week that would require insurers to pay these surprise, out-of-network bills at an amount determined by a database of paid bills, as opposed to simply prohibiting providers from sending these bills to patients. Mississippi’s law greatly favors insurers in this way.
The Harvard report also suggests large, surprise balance bills could be contributing to Mississippi’s high rate of people with past due medical debt — the highest in the country at 37.4 percent.