Gov. Steve Sisolak is calling for the creation of two new state-level positions to help Nevadans resolve out-of-network emergency room billing disputes — an issue the Legislature is poised to again take up in the upcoming session.
The governor’s budget, released last week, recommends spending $510,411 over the biennium to fund two new state workers responsible for helping Nevadans with medical billing issues, particularly in the event that lawmakers pass legislation this session creating a system for resolving disputes between insurance companies and providers over out-of-network emergency room bills. The two positions will fall within the Office of Consumer Health Assistance under the Department of Health and Human Services.
The budget includes $234,243 for the two positions the first year and $276,168 for the second year, including $365,950 in personnel expenses, $32,170 in operating expenses, $109,524 in information services and $2,767 for in-state travel.
Sisolak made surprise emergency room bills a focus of his health-care platform during the campaign and told reporters after a roundtable in December that he was talking with legislative leadership about how to tackle the issue.
“You’ve got people who are sick to begin with and they get a letter in the mail and open it up and fall off their chair. We’ve got to do something with that,” Sisolak said. “It’s definitely a priority for us.”
Though the funding proposal came from Sisolak’s office and not from the department itself, Director Richard Whitley said in an email that the two positions would provide a “needed consumer service.”
“Patients who have healthcare coverage and enter a hospital through emergency room services may be faced with costs not covered by their health plan because the hospital is not in their plan’s network,” Whitley said. “The issue is between the health plan and the healthcare provider but the consumer is the one who is faced with the burden. The consumer is rarely in a position to adequately negotiate a bill. This funding will allow DHHS to add more services to consumers in the area of disputed billing.”
According to the budget, the two positions will help “provide mediation services for disputed billing for out of network service charges incurred during emergency visits,” something that has been previously proposed for out-of-network billing issues. Former Gov. Brian Sandoval vetoed a bill passed during the 2017 legislative session that would have required insurance companies and providers to agree on a “reasonable” rate for out-of-network services or else take the matter to binding arbitration.
In his veto message, Sandoval said that the legislation would have forced hospitals and physicians to accept below-market rates for out-of-network care or take thousands of cases a year to mediation. Doctors and hospitals have expressed concerns about the financial burden of taking a significant number of cases to mediation.
Democratic Assemblyman Mike Sprinkle, who helmed a working group on the issue last year, plans to propose legislation this session that would establish a formula for determining how much insurance companies have to pay doctors and hospitals who have not set contracted rates with them, though he told The Nevada Independent that the numbers he included in his bill draft request are only a starting point for ongoing negotiations. It is unclear whether an arbitration or mediation provision will be part of the final bill if the insurers and providers are able to agree on a rate structure.