Arizona’s Surprise Billing Law Doesn’t Go Far Enough to Protect Patients (video)

On Thursday, January 16, 2020, the Regulatory Affairs Committee started bright and early with a sunset review hearing for three different departments: the Residential Utility Consumer Office (RUCO), the Department of Insurance, and the Arizona Board of Library Examiners. (This post focuses on the Auditor General’s review of the Department of Insurance.)

I have been on the Health Committee since day one and was on the Banking and Insurance Committee for two years (until it was eliminated by the Republicans). As a result, I have heard a lot of insurance bills and am very familiar with the heavy workload the Department of Insurance has. (Often, legislation gives departments more work without giving them more staff or more money.)

Primarily, my questions to the DOI director focused on surprise billing. You may remember that we passed a surprise bill in 2018. At the time, Democrats were concerned that the Republican/lobbyist crafted bill didn’t go far enough to protect patients and didn’t include a sufficient (or any) appropriation to run the surprise billing complaint department.

Surprise bills are healthcare bills that you didn’t know you owed. people generally receive surprise bills after the insurance company and the patient have paid their share of the care that was provided. The problem is that sometimes there are out of network providers, for example, in an operating room. While you’re under, you don’t know that the anesthesiologist is not covered by your insurance. We all assume that when we show our insurance card things are going to be covered.

The director said that one DOI staff person has been assigned to surprise billing, and that’s enough because not very many patients have filed formal complaints. Only 75 surprise billing complaints were received in 2019 and out of those 75 patients, 15 patients had complaints that were deemed to be legitimate for adjudication. Those 15 people got a total of $30,000.

I was shocked that the reach of this surprise billing complaint process was so minimal in a state with 7 million people. I know 15 people in my district who have surprise billing complaints, including my daughter and her husband. They have been charged tens of thousands of dollars in surprise bills since my granddaughter was discharged from the Nursery Intensive Care Unit (NICU) a year ago. Yes, more than a year after my granddaughter was born, they are still being billed. The TMC NICU holds ~30 tiny patients at a time. I am sure those other tiny babies’ families have similar surprise billing stories. And that is only one NICU in this state.

As the Democrats had theorized back in 2018, what we passed didn’t go far enough to protect patients. Rep. Kelli Butler and I worked with Senator Debbie Lesko to make her bill more patient-friendly. I insisted on a patient portal on the DOI website where people can start the complaint process and a printed notice on the surprise bill telling people they can protest the bill and giving them the DOI phone number and website address.

We need to fix this. Obviously, there are many more surprise bills out there, and people don’t understand the complete process.The DOI director said that Texas has already amended their surprise bill. He had suggestions– like lowering the threshold from $1000 to $500. He also said that they have published a surprise billing report, which he will send to me.

We should look at the report, our law and fix it. Or, we eliminate surprise billing all together and overhaul the healthcare insurance system. Medicare for all, anyone? The system we have today only works for big insurance and big Pharma, not the rest of us, obviously.