Two new protections coming for patients

Impact of recently-signed Idaho Patient Act remains to be seen

Paul Amador’s son Peter was only a few months old in December 2017 when the baby developed a case of croup.

“We were visiting family,” Amador recalled of the California trip. “Being a new dad, it’s obviously scary, so we took him in to get checked out.”

Peter recovered under the care of Paul, his wife Julie and a California emergency room. But in early 2019, the croup once again reared its ugly head.

“I was shocked,” Amador said. “I couldn’t believe it.”

The disbelief was not over his son’s health. Peter was fine, healthy and croup-free. No, what came back to haunt the Amadors was a bill more than a year later for $25.

“I thought, ‘This is ridiculous,’” Amador said with a laugh. “We get a bill for $25, 13 months later, with no rhyme or reason to it? It didn’t make sense.”

While the $25 didn’t break Amador’s budget, the principle was one of the reasons the state legislator representing Coeur d’Alene voted for the Idaho Patient Act, Idaho’s newest patient protection bill signed into law by Governor Brad Little on March 16. The Idaho Patient Act goes into effect Jan. 1, 2021.

“I know a lot of people who can’t afford those kinds of surprises,” Amador said. “There are a lot of Idahoans who thought they paid their medical bills but now have to deal with little bills following them.”

Its passage into law comes as the state — along with the rest of the world — is still spiraling into coronavirus madness. The fear of contraction and spread has compelled governors across the country, including Little, to order stay-home orders that closed businesses and laid off employees, cutting people off from their health care.

The Idaho Patient Act, originally HB 515, is essentially a two-part consumer protection law. The first part requires health care facilities to provide a consolidated summary of services to patients, and establishes a timeline to work with insurance companies. The second part limits what debt collectors can do to recover costs for those services.

“If you have a procedure done, you’ll get a separate bill from the lab, and a separate bill from the anesthesiologist, and a separate bill from the doctor, and another bill from a specialist,” Amador said. “The new law provides clarity to your medical billing process. Most people I’m familiar with want to pay their bills. They just want to know what they owe and how they can go about paying it.”

The earliest COVID-19 patients across the country are now starting to get their first bills, with price tags ranging from $300 to $34,000. Those who don’t pay those bills will likely see their debt fall into collection, which is where the second part of the Idaho Patient Act goes to work. The new law requires a provider to send bills to third-party payers — such as insurance companies — within 45 days. Within 60 days, the provider is required to send a consolidated summary of services to the patient.

The Idaho Patient Act also caps on a sliding scale the legal fees for patients who have found themselves targeted by what the bill calls “extraordinary collection actions,” which include liens, seizing bank accounts, civil actions and garnishments.

Jennifer Dancy, compliance officer and manager of Advanced Accounts Recovery, a debt collection agency in Coeur d’Alene, said they have abided by local, state and federal laws, and they’re prepared to do so after the law takes effect.

“With the respect of the cost of doing business, just being aware of the laws and Idaho Code and how it’s modified, we’ll make sure to maintain compliance,” she said.

Kim Anderson, communications director at Kootenai Health, gave a tempered response to the bill’s passage and its prospects.

“We appreciate the intent of this legislation, but only time will tell how beneficial it will be for patients,” she said. “Idaho hospitals are still evaluating the changes we will need to make to our internal processes in order to comply with the bill.”

That compliance is not always in a hospital’s control. Getting an insurance company to respond with prompt payment is something the law’s opponents said couldn’t be legislated in Idaho.

“To think that I can’t send a patient to collections because our bill made it in on day 46 or day 51 is unconscionable...45 days just doesn’t work,” Katie Davenport, owner of an the Idaho Falls medical billing company Entrada, testified to the Legislature’s Business Committee in February.

Davenport cited work shortages, retroactive insurers, secondary insurance companies, reciprocal billing arrangements and certain specialties that would vanquish any hope of making the 45-day deadline soon to be in effect.

Amador, meanwhile, said patients faced with these mounting bills are following a similar logic to that of insurance companies.

“A lot of well-meaning people will say, ‘I got this bill, and my plan is just not to pay for it until I hear from my insurance company,’” he said. “‘My plan is to let the insurance company take care of it.’ It’s just not a very efficient way to run anything.”