ATLANTA — Georgia lawmakers considered insurance bills Wednesday that would create major changes in health plan networks in the state.

The Senate Insurance and Labor Committee first heard testimony on Senate Bill 143, which would require the state employee and teacher health plan to include the state’s five Level 1 trauma centers as “in-network” facilities.

That would help Grady Health System, a trauma center in Atlanta that is now “out-of-network” for Blue Cross and Blue Shield of Georgia members.

Blue Cross is the main insurer in the State Health Benefit Plan. So approval of Senate Bill 143 would make Grady in-network for the plan’s 630,000 members.

The state of Georgia has similar requirements with the health plans that serve Medicaid and PeachCare members, said Sen. Chuck Hufstetler (R-Rome), lead sponsor of the bill.

Grady Memorial Hospital has been out-of-network for Blue Cross’s health plan members since late November, after a contract between the two organizations expired and negotiations on a new one broke down.

Grady CEO John Haupert told the Senate panel that because of the out-of-network status, State Health Benefit Plan members recently have left the facility still owing thousands of dollars.

“Members are walking away from Grady with tremendous medical bills,” Haupert said.

The Senate panel took no vote on the legislation, which is similar to a House bill that passed a subcommittee.

A second insurance proposal, Senate Bill 158, would place limits on health insurers in several ways, including in their creating “narrow networks.”

That’s the increasing trend of insurers to offer consumers more limited choices of medical providers.

The bill’s lead sponsor, Sen. Dean Burke (R-Bainbridge), a physician, told the Insurance and Labor Committee that the legislation would help rural doctors “have a fighting chance” to remain financially viable.

“I represent a rural independent physician,” he said. “There are a lot of reasons that we are about to be extinct.”

The bill would require health plans to maintain an adequate network of physicians and other providers so that services would be accessible to patients “without unreasonable delay.” The state insurance commissioner would develop guidelines on networks, Burke said.

Opposing the bill is the insurance industry, which testified that cost increases in health care are continuing at an “unsustainable rate.”
Allan Hayes of America’s Health Insurance Plans added that consumers and small businesses prefer narrower networks that are cheaper, rather than broad networks of providers that are more expensive.

“Health care is the most regulated sector of the U.S. economy,” Hayes said.

But Cindy Zeldin of Georgians for a Healthy Future testified that consumers often have too little information during enrollment periods to determine how narrow or broad a network is. Lists of providers in an insurance network are frequently out of date, she said.

The bill would also prohibit health insurers from forcing a physician contracted in a particular health plan to participate in all of the plans offered by that insurer in the state. And it would restrict insurers from making unilateral changes to contracts with providers.
The Senate panel decided to form a study committee to analyze the narrow network bill.

Burke said after the hearing that the decision was fine with him. The issues were complex enough to deserve further study, he told GHN.


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