What They’re Watching: Rep. Jim Dunnigan

Rep. Jim Dunnigan is the Chair of the Health Reform Task Force, a legislative interim committee that works to address issues in health care and determine legislative priorities. Rep. Dunnigan will also be a featured speaker at our Colorado State of Reform Conference, where he will discuss Utah’s ongoing Medicaid expansion efforts.  He joins us in this edition of “What They’re Watching” to discuss balanced billing.

One of the big issues that we need to address is balance billing or surprise billing, where a person goes in, let’s say emergency room, they might even be unconscious and it’s not in their insurance network…their health plan pays the same amount they would have paid had they gone to a in-network ER and then they’re sent a bill for hundreds or thousands or tens of thousands of dollars. It’s a consumer issue and we’ve got to get the consumer, the patient, out of the middle. 

 Two years ago I sponsored legislation– it passed the House, did not pass the Senate. We worked on it again this session and we’ll work on it this interim. One of the things we’re looking at now is an arbitration model where we get two different stakeholders together and it goes to an arbitrator and they decide what’s fair payment. The whole point of it is to get the patient out of the middle.

 The federal government is looking at it [surprise medical billing] but they also often look at a lot of things and don’t do much– they actually might do something this year. Washington [DC]  just passed a law last week…. so where in fact we were just having a discussion–one of the things I like about this conference is the hallway discussions. I was talking to some people about balance billing and they shared some ideas of things that we can do. For example , if you’re a provider and you’re out of network for somebody if you want to bill that person’s insurance then you have to agree to accept whatever that insurance plan pays you or you tell the patient “I’m out of network I’m not going to bill your insurance” but you have to tell them that out front.