SALT LAKE CITY, Utah (ABC4 News) – Utahns are getting stuck with tens of thousands of dollars in medical debt, even though they have health insurance.
One state lawmaker says enough is enough, and he’s running a bill to change it.
Imagine this; you suffer a medical emergency, you’re unconscious and someone calls for help on your behalf. Then you are taken to an emergency room that is out-of-network.
It’s called balance billing, and it’s leaving some with an insurmountable bill.
Mike Lyons of Millcreek is one of them. Earlier this year, he was at a rock climbing facility when he suffered a traumatic back injury.
“I was taken to the hospital by ambulance and was unconscious, so I was just taken, I assume, to the hospital that was closest or best equipped to take care of my back injury,” Lyons said.
That hospital was Intermountain Medical Center in Murray, which is an out-of-network provider for his insurance policy through Regence.
“Now, almost a year later I’m getting a bill for $42,000,” he said.
Federal law requires the insurance company to pay what they would pay an in-network provider for an emergency room visit, but the out-of-network provider can then go after the patient for the balance.
Representative Jim Dunnigan says it’s a big problem in Utah.
“It does not seem right to me that if you are taken to an emergency room, and your insurance plan pays everything they are required to by law that you should worry about receiving a bill for additional charges, above what they have paid,” said Dunnigan, (R) Taylorsville.
In 2017, Dunnigan unsuccessfully ran a bill to eliminate balance billing.
In the meantime, he’s been working with insurance companies and medical providers to try to broker a solution and is bringing the bill back this year.
He wants to require insurance companies to pay providers a reasonable and fair amount for emergency services, and for the provider to leave the patient out of it.
“They did everything they were supposed to. They had health insurance and it covered the emergency room, so it sends them into bankruptcy. It’s just catastrophic, it destroys them,” Dunnigan said.
That’s exactly the reality Lyons is facing, as he goes back and forth with the companies trying to get something worked out.
“My house needs a bunch of repairs and I need to put a new roof on it, and I don’t know how I can pay for that when I have to pay a $42,000 bill that I had, I had no input in terms of what hospital they were going to take me to,” said Lyons.
A spokesperson for Intermountain says they have been working with Representative Dunnigan to find a “good resolution” and they believe they are “very close to one.”
Tuesday, the Health Reform Task Force will take up the issue.
Representative Dunnigan would like anyone who has gone through this to show up and share their stories.
The meeting starts at 1 pm. in room 445 of the State Capitol.