Rep. Marcus McEntire

Rep. Marcus McEntire

After agreements couldn’t be reached in the last session, a local legislator has announced ‘surprise medical billing’ will be prohibited in Oklahoma soon.

According to Rep. Marcus McEntire, R-Duncan, a surprise medical bill is a medical bill received for healthcare rendered to a patient when the patient believes the health care provider is in the patient’s health insurance network but is not. In situations like these, a surprise bill occurs because the patient is billed by an out-of-network provider for the balance of the costs the insurance company doesn’t pay to the out-of-network provider. In most cases, the patient has no knowledge the provider rendering care is out of the patient’s network.

"Surprise bills commonly occur when a patient receives care from an out-of-network physician in an in-network hospital," McEntire said.

Negotiations on the surprise bills started in the last legislative session between the Legislature, the Oklahoma Insurance Department, health care providers and health insurers, but agreements weren’t reached before the session ended.

“After the last session, we were discouraged about the pace of the surprise billing negotiations,” McEntire said. “However, we are extremely pleased with the pace of negotiations over the interim. We are happy to announce an agreement with health providers and insurance companies to hold enrollees harmless to surprise bills and prohibit the practice of surprise billing. Both the insurance companies and health providers emphatically stated in our meeting that patients should be held harmless.”

McEntire says one goal for the upcoming legislative session will include running a bill prohibiting these surprise bills.

“There is still hard work and tough decisions ahead,” McEntire said. “The difficult challenge is to find an agreed-to method for insurance companies to compensate out-of-network providers. We have encouraged health care providers and insurance companies to negotiate a fair system of compensation or a mediation process and bring it to us. We want to see a payment system on which both sides can agree and a system that does not cause insurance premiums or the cost of health care to rise more than it already is.”

The legislative session begins Feb. 3, 2020.

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