NC Senate passes ‘no surprises’ medical charges bill. Will the House let it die again?

The state Senate has unanimously approved legislation that would prevent patients from getting a surprise bill for a medical service not covered by their insurance.

But despite that endorsement, the bill’s fate in the House remains uncertain. The Senate unanimously passed a similar bill last year that went nowhere in the House, amid questions of whether a federal law may make a state one unnecessary.

Senate Bill 46 would require hospitals and other health care facilities to notify patients in advance if they will receive a bill for a service not covered by their insurance. The written notice would be due at least 72 hours in advance of a scheduled procedure or “as soon as reasonably possible” in an emergency.

Sen. Jim Burgin, who owns an insurance company with offices in Angier and Lillington, said he frequently hears from customers who went to a hospital or other facility in their insurance network, only to get a bill weeks or months later from someone involved in their treatment, such as a radiologist or anesthesiologist, who didn’t accept their insurance.

“I’ve dealt with this for 33 years of people not having information, and I think there needs to be medical transparency,” Burgin, a Republican and one of the bill’s three primary sponsors, said in an interview. “Because it’s not fair for somebody to go and have treatment and then be surprised by a bill that they didn’t know they were going to get.”

The Senate voted 48-0 in favor of the bill on Feb. 21. The House sent the measure to its Rules Committee, which is where last year’s version of the bill languished without a vote.

Burgin says some lawmakers think the bill is unnecessary because of a federal law, the No Surprises Act. That law bans surprise out-of-network charges for most emergency and some non-emergency services. It went into effect Jan. 1, 2022, and by the end of September had prevented consumers from receiving as many as 9 million surprise bills, according to a report highlighted in Healthcare Finance News.

But the federal bill has run into trouble over the arbitration system it set up to determine how out-of-network providers should be compensated. The Texas Medical Association and several national groups representing hospitals and physicians have contested the process, saying it favors insurers, and a recent court ruling in Texas may force regulators to try again.

Does federal law make the bill unnecessary?

Supporters of SB 46 say the federal law shouldn’t prevent North Carolina lawmakers from acting. For starters, they say the No Surprises Act doesn’t apply to all procedures and services, leaving patients vulnerable to some surprises.

And they note that the state bill takes a different approach. It would simply require that patients be told about potential out-of-network bills in advance so they can make an informed decision, said David Smith, who heads up the legislative committee for the N.C. Association of Benefits and Insurance Professionals.

“We’re trying to add another level of protection for North Carolina consumers,” Smith said in an interview. “We want people to be aware of the cost and the consequences of having out-of-network providers and what they can wind up paying, even with or without No Surprises Act protection.”

Not everyone is convinced that added level of protection is needed.

The N.C. Medical Society, which represents physicians and physician assistants in the state, hasn’t taken a position on the bill, said spokesman Randy Aldrich. In a written statement, the society said it supports protecting patients from unanticipated bills due to non-network medical services but wants to understand how the bill “would interact with” the new federal law.

“We are still reviewing the proposed language of Senate Bill 46 with our members, stakeholders, and patients as it heads to the House,” the statement said.

The N.C. Healthcare Association, which represents all 130 hospitals in the state, is also still studying the bill and hasn’t taken a position, spokeswoman Cynthia Charles said.

Burgin said before helping draft SB 46, he considered introducing legislation to solve the problem of surprise billing by requiring anyone providing services at an in-network hospital or clinic to accept in-network compensation.

“But I’m a business guy, and I don’t want to mandate to people what they can do,” Burgin said. “ I just want the consumer to be informed. I want you to know that you’re going to get a bill. Then you have the opportunity to make a decision. Even if you’re in the ER, you have the right to know.”