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Proposed legislation attempts to address surprise medical bills

Joe Irizarry
Delaware Public Media

Delaware lawmakers are trying to help cover the cost for patients who end up paying more than they expected for a medical visit. 



A bill in the Delaware House seeks to further protect Delawareans from “surprise” medical bills. 

These can occur when a patientreceives care in the Emergency Department from a provider that’s not in the patient’s network, or when a patient receives non-emergency care from an out-of-network provider at an in-network facility without this being told in advance.

“The classic case is: somebody goes to the emergency department, is admitted to the hospital, they go up into the OR and the anesthesiologist that performs that function is not in network with the insurer who insures the hospital. The patient would then get a bill separate from the anesthesiologist,” explained Delaware Healthcare Association President and CEO Wayne Smith, who supports the measure.

Delaware already protects patients who incur these types of charges in the ED, but the new bill would also cover the cost of surprise bills received by patients in non-emergency medical facilities.


“Facility visits, procedures that do not arise in the emergency department can still result in surprise bills," said Smith. "It doesn’t happen nearly as often as it does in states that don’t have this protection for emergency department surprise billing, but it’s still a factor. It still causes concern and sometimes financial hardship for patients.” 

Like the law covering emergency department visits, the new bill requires insurance companies to negotiate with the provider on how a “surprise” service is paid for, and there is an arbitration process if the two sides can not reach an agreement.

Smith notes the bill sponsored by House Democrats appears to have bipartsan support.