November 14, 2017
Ohioans who need certain medical procedures would be able to get detailed cost estimates before undergoing the processes under legislation detailed by a House Republican on Tuesday.
Rep. Steve Huffman (R-Tipp City) said the bill would impact procedures that require prior authorization, helping consumers shop for providers and facilities that might have lower rates.
The bill would succeed a related two-year-old law that has never been implemented due to an ongoing court challenge, he said. That provision was included in a BWC budget bill (HB52, 131st General Assembly), and was challenged in court by a coalition of medical organizations.
Mr. Huffman, who chairs the House Health Committee, said patients, hospitals and physicians want transparency in the system, and the bill would help achieve that goal.
The cost estimates would require providers to offer a good-faith estimate of costs, including the expected cost to the patient and information about whether the provider is out of the patient’s insurance network. Some patients, he added, trust their doctors and hospitals and won’t seek the information.
Regardless, the information would help patients make more informed decisions about their care, the lawmaker said.
Rep. Huffman said he envisions the process being implemented for procedures that don’t require prior authorization in the future. He added that the bill doesn’t address emergency situations, and other cases when time might be of the essence.
The bill is supported by the OHA and the OSMA both stating that it provides an appropriate level of expectation and responsibility on both the provider and the insurer.