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House passes balance-billing and network-adequacy bill after lengthy floor debate
Summary
The Utah House passed the fifth substitute to House Bill 395, a package aimed at reducing surprise medical bills and improving insurer network transparency. The measure requires network adequacy demonstrations, updated online directories, direct payment to ER providers for emergency claims and a benchmark-based cap on balance billing.
The Utah House passed the fifth substitute to House Bill 395 on March 6, 2017, approving a set of measures intended to curb surprise medical bills and strengthen continuity of care for patients treated in emergency rooms.
Representative James A. Dunnigan, the bill sponsor, told colleagues the bill requires health plans to demonstrate adequate provider networks to the insurance commissioner and to post updated provider directories at least every 30 days. The substitute also requires plans to pay non‑network emergency providers at an in‑network level of benefits for up to 90 days following ER care and to remit payment directly to those providers to prevent patients from being chased for balances.
The bill includes an exemption for clinicians who spend the vast majority of their practice in the emergency department: those who dedicate more than 95 percent of their time to the ER are excluded from the mandatory balance-billing limits. Representative Dunnigan said the measure uses a national, independent database to set the benchmark that limits allowable balance billing, and he supported a floor amendment (moved by Representative Ward) that adopted that approach.
Supporters described the package as a patient-protection measure. Representative Elizabeth E. Eliason said she had seen surprise billing affect family members and called the bill a necessary protection for low-income households. Opponents — including representatives who said they had heard from physicians and hospitals — warned the changes could give insurers leverage over provider reimbursement and might harm access in some markets.
Floor debate included numerous technical exchanges about how the benchmark would be set and whether the statutory language gave insurers undue leverage; Representative Ward’s amendment to anchor the cap to an independent database was adopted on the floor. After extended discussion and an amendment process, the House approved the fifth substitute 39–34 and transmitted the bill to the Senate for further consideration. The bill includes a three‑year sunset for the policy and exemptions for certain low balance‑billing providers.
