Mississippi law currently allows health care providers to “balance bill” patients. This is when a provider bills the patient for the difference in the initial charges and what the patient has paid after receiving insurance benefits. Clarion Ledger discovered that the law is not easily enforced. House Insurance Chairman Rep. Gary Chism (R-Columbus) authored a bill that would require the attorney general’s to enforce the law, and to establish binding arbitration to settle any balance billing disputes between patients and providers. According to a Mason-Dixon survey conducted for the Mississippi Health Advocacy Program, an overwhelming majority of Mississippians supports anti-balance billing. 40% of the 625 Mississippians surveyed in January said that they had ever received a surprise medical invoice. Eighty-five percent supported laws that would require providers and insurers in order to resolve billing disputes. Chism stated that several legislators who are also nurses or nurse practitioners approached him to oppose his bill. The deadline for bills to be passed out of committee was Tuesday. Chism stated that “they want to be in a position to get their money.” Balance billing is against state law. However, due to the complexity of insurance and health care, patients are more susceptible to being ripped off, advocates for health care say. Many people are unaware of the existence and proper interpretation of anti-balance bill law. Roy Mitchell, director Mississippi Health Advocacy Program stated that there are two problems. Many people don’t understand what balance billing is. After they have been balance-billed, they don’t know where or how to get help. For example, a provider might charge a patient $1,000, but an insurance company may allow $500. This is the amount the insurer believes the provider should be paid. The insurer may have to pay $400. In addition to the $100 deductible, the patient might also be required to pay $20 co-insurance. The state law states that the provider must accept the payment even though it has received only $500. The provider could try to recover the $500 remaining under “balance bills” which is a prohibited practice. This was a 2013 state law. According to Mississippi Insurance Department documents, University of Mississippi Medical Center charges $5135 for a colonoscopy and biopsy, but will accept a $177 discount from Blue Cross Blue Shield of Mississippi for the same service. Unknowingly, a patient receives services from an outside-network provider. This could be a radiologist in an in-network hospital or a radiologist who is not enrolled in negotiated discounts. Out-of-network providers are paid less than those in their network. This results in a higher bill for the patient if the provider sends a balance invoice. The law says that Mississippi’s antibalance billing does not distinguish between types. Providers who accept insurance payments from Mississippi are considered to have paid the full amount. However, the provider may not bill the insured or collect any additional amounts beyond the payment. This includes the deductible, coinsurance or copayment, and other costs for equipment or services that the insured requests that aren’t covered benefits. Despite the fact that balance billing is common, Chism introduced a failed bill to strengthen Mississippi’s antibalance billing statute. Patients can complain about balance billing to the Mississippi Insurance Department. The agency can mediate the matter but it doesn’t have the power to force providers to follow the law. Similar to the attorney general’s office, it has said that it can not enforce the law. Patients would then have to sue uncooperative providers privately. Chism stated to Mississippi Today that patients shouldn’t be required to spend money to hire an attorney to draft a letter. This was before the 2019 session started. “Someone should look at it and say, ‘This is a bill. It’s not your obligation. Chism stated that Chism’s legislation was twice referred to the House Insurance, Judiciary A and House Insurance committees. This usually means “the leadership are not too keen on it”. The deadline for bills to be submitted to their respective committees was Tuesday. Chism stated that Speaker Philip Gunn (R-Clinton) had not expressed any concerns about the proposal. However, Chism was approached to discuss the bill by several health care provider lawmakers. Chism stated that they opposed the anti-balance billing bill, which was passed in 2013 under the radar. Chism stated that they said the law had “snuck through” and didn’t want it to be dealt with in an election year. The law could also be controversial for the Capitol’s largest lobby, the health-care sector. Rep. Jarvis Dortch (D-Raymond) also wrote a bill that addressed balance billing. This would have required providers and patients to be better informed about balance billing and the options for mediation. It was also killed. Chism called Dortch’s bill “much less radical than mine,” even though Chism, the chairman of the insurance industry, had thought about replacing Dortch’s language with his legislation to get it passed through the House Insurance Committee. Chism stated that “that would have been sort of in the face the leadership.” “I decided it wasn’t worth it.” According to a 2017 Urban Institute study, Mississippi had 37 percent of those with past due medical debt between 2012 and 2015. The leading cause of bankruptcy in America is medical debt.