Kansas among worst states for surprise medical bills. Congress just banned them
What began as a routine exam six years ago for Jaime Orlich left her with something she’d never gotten before. A bill for a pap smear. A big bill for more than $3,000.
She told herself, “don’t panic. It’s clearly a mistake.” But it wasn’t. She got slammed because the pathologist who provided services was out-of-network, services not covered by her medical insurance.
At the time she was working as a medical financial advocate at a local cancer center, and she gets the irony.
“I’m not angry about it to this day, but it still just blows my mind because I worked as an actual expert on surprise bills,” said Orlich, 33, an Overland Park mom of three who works as a medical coder now.
On Monday night, Congress passed a ban on surprise medical bills, something patient advocates had wanted for years. The ban — part of a sweeping COVID-19 relief package that also includes $600 checks for many Americans — will mostly end the shocking invoices that can show up in mailboxes months after an emergency room visit or surgery. The legislation now heads to President Donald Trump’s desk.
The bills occur when patients seek medical care from a provider within their insurance network only to find out later that some part of their treatment came from an out-of-network provider. The result is that people with even robust insurance coverage wind up on the hook for thousands or tens of thousands of dollars.
Kansas is one of the worst states in the country for surprise medical bills, though they afflict residents everywhere. A quarter of Kansas emergency room visits in 2017 resulted in at least one out-of-network charge, according to an analysis released earlier this year by the Peterson Center on Healthcare and the Kaiser Family Foundation.
The analysis ranked Kansas among the six states with the highest percentage of out-of-network emergency room charges, along with Texas, New Mexico, New York, California and New Jersey. In Missouri, which has a state-level surprise billing law, just 9% of visits included an out-of-network charge.
“It’s just a tough problem for the consumer because they don’t really, in that situation, obviously know that until it’s too late and they get the bill,” said Linda Sheppard, a senior analyst at the Kansas Health Institute
The bill approved by Congress requires emergency rooms to bill patients at network rates, regardless of whether the patient is in the network. It protects patients from charges that occur when out-of-network doctors assist with procedures at in-network hospitals.
Air ambulance services are also prohibited from billing patients at out-of-network rates — a significant development in rural states like Kansas where hospitals are often many miles away. Medical airlifts are expensive, with bills running into the thousands of dollars.
“Kansans will no longer be held hostage by health care groups and worry about what bill may come in the mail,” said David Jordan, president of the Hutchinson-based United Methodist Health Ministry Fund.
Orlich’s surprise bill happened simply because she didn’t realize that the practice of the OB-GYN she had been seeing for several years had been acquired by another hospital system out of her network.
After her pap smear came back abnormal, she was scheduled for a quick hysterectomy. Only then did she take a closer look at her insurance plan and discovered the hospital she was being sent to wasn’t in her network.
Her procedure could have resulted in a bill of $20,000 or more if she hadn’t checked and gone somewhere else, Orlich said.
“And surgery inevitably led to a really freak post-op complication that landed me in the ER and another surgery,” Orlich said. “I start to think about $3,000 doesn’t seem so bad compared to the hundreds of thousands I would have owed … because it was like boom, boom, boom, schedule, in and done.”
“If it had not been caught I would have been overwhelmed,” she said.
Chris Costantini, a 28-year-old Kansas City resident, is still paying off a roughly $2,000 out-of-pocket bill from a 2018 fall in which he hurt his right shoulder and was taken to a hospital by ambulance. He said the ban had been a “long time coming.”
“Especially in unforeseen emergency circumstances, it’s something that people dread,” he said.
The hospital where Costantini was taken was out of network. He ultimately received a bill of about $1,400 for the emergency room, in addition to the ambulance.
Since the provider wasn’t in his insurance network, Costantini was unable to negotiate with the provider, though he said he tried.
“It’s just such a medieval, arcane system that we have here,” Costantini said.
The bill also includes arbitration provisions in the event that insurers and providers can’t agree on costs, as well as a 30-day period before arbitration to encourage negotiations.
“That’s what should happen. They should get together at a table and figure out what the fair price should be,” said Christopher Garman, an assistant professor of health administration at the University of Missouri-Kansas City.
While the legislation will end many surprise bills, it doesn’t eliminate all possibility of unanticipated charges. Ground ambulance services, which can be expensive, aren’t included in the bill.
Surprise medical bills have drawn attention from lawmakers for years, but efforts to address them in the past had fallen apart. A major push in Congress in 2019 ended without success, but Jordan said the 2020 deal showed lawmakers had remained committed to working on the issue.
Rep. Sharice Davids, a Kansas Democrat who introduced a ban on surprise medical bills last year, said late Monday that in the middle of a pandemic “the last thing Kansas families need is a medical bill they never saw coming.”
“This bipartisan, bicameral bill will go a long way to protect patients from surprise medical billing and prevent this harmful practice. I was glad to work with my Republican and Democrat colleagues to get it done,” Davids said.
Rep. Ron Estes, a Kansas Republican who voted for the bill, earlier this month called surprise medical bills “an issue that can affect Kansans even when they do their due diligence to find covered providers.”
Orlich said when she received her surprise $3,000 bill she was lucky to have already had experience working and fighting within the system from her job as a medical financial advocate.
Still, Orlich had to go back and forth with her pathologist, an ordeal she called a nightmare.
“I don’t know how I would have done it if I didn’t know what I knew,” she said.
The Associated Press contributed reporting
This story was originally published December 23, 2020 at 5:00 AM.
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