Some states have put a clamp on surprise medical bills — but not R.I.

By Lynn Arditi
Published November 26, 2016

Five states have enacted laws to protect against or prohibit surprise medical bills, according to a survey map by Consumer’s Union.

Rhode Island is not among them.

The laws range from Illinois’ requirement that insurers warn consumers that they will have limited coverage for out-of-network care to Florida’s outright ban on billing patients for the difference between what the health-care provider charges and what the insurer reimburses for out-of-network care — a practice known as “balance-billing.”

California, Connecticut and New York have also enacted laws in recent years to protect against surprise out-of-network bills.

New York’s law, enacted in April 2015, is among the most far-reaching in that it generally prohibits surprise billing by out-of-network providers. The law also protects all patients against surprise bills for emergency services.

Other states, including Colorado, Maryland, New Mexico and Texas, offer lesser protections, according to a study by the Robert Wood Johnson Foundation.

In Rhode Island, a bill introduced in the General Assembly last session by Rep. Robert E. Craven Sr., D-North Kingstown, would have required the state health insurance commissioner to establish a dispute-resolution process for bills arising from emergency services and surprise medical bills from out-of-network providers.

Health Insurance Commissioner Kathleen D. Hittner supported the legislation but said it didn’t go far enough. “The proposed legislation provides a process for the patient to dispute a bill for a service from an out of network Provider,” Hittner said in a letter to House Corporations Committee Chairman Brian Patrick Kennedy. “However, we need to do much more than just provide a dispute process — we need to go much further in managing this problem.”

Hittner suggested her agency work with the bill’s sponsors and other stakeholders to see how other states, such as New York, have addressed the issue.

The Senate approved a companion bill sponsored by Sen. Stephen R. Archambault, D-Smithfield. But Craven’s House bill died in the House Corporations Committee.

Craven said he plans to re-introduce the bill for the session that begins in January.


On Twitter: @LynnArditi