Opinion

Colorado’s health care consumers get some new safeguards, could use more

Author: Adam Fox - May 21, 2018 - Updated: May 21, 2018

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Adam Fox

The Colorado 2018 legislative session was full of bills on a range of health care issues, but legislative gridlock prevented progress on important issues for consumers like out-of-network surprise bills, rising drug costs, too little insurance competition, and skyrocketing insurance costs.

However, Colorado lawmakers did succeed in passing legislation that will help consumers who utilize freestanding emergency rooms (FSERs).

Coloradans’ frustration with unexpectedly high bills and confusion from FSERs finally became too much to ignore. Legislators noted the overabundance of Coloradans who walk out of an FSER with bills as high as $5,000 for a bloody nose that wouldn’t stop, $6,000 for a sinus infection, or individuals who were hit by huge bills because FSERs closely resemble urgent care centers. Instead of increasing access to care where it’s needed most, these ERs are often placed in high-income neighborhoods where traditional hospital ERs are already accessible.

The Colorado Consumer Health Initiative worked with legislators on three bipartisan bills to deal with FSER challenges. With the enactment of SB18-146, Coloradans can now expect basic notification of costs in FSERs once it’s clear they are not having a medical emergency. SB18-146 threads the needle between ensuring people have a clear understanding about the costs of care in FSERs and federal laws that prohibit hospitals and ERs from discouraging people from seeking care in a medical emergency.

Colorado legislators also filled an important information gap with HB18-1282. FSERs currently file claims under the umbrella of a hospital with which they are affiliated. While stories from Coloradans made it clear there are serious cost concerns with FSERs, there is little data that could be directly attributed to FSERs because claims couldn’t be separated from the affiliated hospital. This bill fixed that problem by ensuring each facility uses its own identification number for claims.

Unfortunately, legislators failed to pass a new licensure requirement to set clear standards for FSERS — ones that would be substantially similar to the standards of traditional ERs. Currently, not all FSERs are equipped to treat emergencies such as heart attacks and strokes, and may not be equipped to perform some surgeries or lack an operating room altogether. In serious cases, a patient may have to be transferred to a hospital with a fully equipped ER, delaying life-saving care and adding cost. To add insult to life-or-death-injury, the patient could have two facility fees; one for the first ER that, despite its claim as an ER, couldn’t help in an emergency, and one for the second ER, not to mention the ambulance fees for the ride between facilities.

It is an important victory that Coloradans will now receive basic notification of costs in FSERs and policy makers will now have accurate claims and cost information from these facilities. However, in addition to licensing standards for these facilities, there are still the issues of high facility fees associated with FSERs and hospitals, and more broadly, doctors not participating in the same insurance plans as the facility where they treat patients, resulting in Coloradans receiving surprise out-of-network bills.

Legislators did have an opportunity to help consumers with those surprise out-of-network charges. We worked on a bill, SB18-237, that would have have required facilities, doctors, and insurers to notify consumers of their rights and protections when receiving one of these bills. The bill also would have required doctors to repay consumers who erroneously paid balance bills. Despite bipartisan sponsorship and months of discussion to craft this year’s bill, Republicans in the Senate killed this year’s attempt, and many Coloradans will likely continue to pay bills they may not legally owe. You’d think simply notifying Coloradans of their rights would be a little-contested priority, but underlying disagreements between insurers and providers about repayment and the reasonableness of out-of-network charges mean Coloradans remain stuck in the middle holding the tab.

Coloradans can count on better notification in freestanding ERs thanks to those that have shared their stories publicly and a flash of bipartisanship in an election year — but have yet again been left waiting on more robust consumer protections from ill-equipped facilities, surprise medical bills and excessive facility fees.

Adam Fox

Adam Fox

Adam Fox is director of strategic engagement for the Colorado Consumer Health Initiative.