HELENA - Billings state Rep. Cary Smith wants the health care industry to provide consumers with estimates on what medical procedures will cost them, and presented two bills Friday that he said work toward that goal.
Industry representatives showed up to support the measures, but only if the bills are substantially amended - and Smith said he's confident the amended versions still would be good steps toward informing consumers about medical and health insurance costs.
"(It) helps the consumer to make a decision on, 'What's going to be the bottom line?' " he told the House Business and Labor Committee.
Smith, a Republican, is sponsoring House bills 263 and 264. The first bill would require hospitals, physicians and other health care providers, upon request, to give patients an estimate on a "health care service or course of treatment" that exceeds $500.
HB264 requires health insurers, when requested, to give customers a summary of the coverage and out-of-pocket costs for the same thing. Both bills say the health care provider or health insurer shall make a "good-faith effort" to provide accurate information.
Smith related his own experience of shopping for health insurance after he retired three years ago, saying the first offer (from his old company) came in at $1,200 a month for him and his wife, or $14,400 a year. They later found a policy for about $7,500 a year with a $6,000 deductible, but it permanently excludes coverage for some prior medical conditions, he said.
Smith said that experience persuaded him to look for ways to reduce health care costs, and that he felt increasing competition in the industry is the way to do it. His bills are an effort in that direction, he said.
"It's important for me as a consumer to make sure my health care dollar goes as far as it can," Smith told the panel.
The amendments offered on behalf of hospitals, physicians and insurers remove detailed language on what the price estimates for health care procedures should contain, such as a list of all providers that might be involved, the anticipated "total charges," or a treatment plan for mental health or therapy services.
Pat Melby, a Helena attorney representing the Montana Medical Association, said the primary physician on a procedure couldn't reliably provide such information, because the procedure could involve many different providers who work independently.
He referred to his own recent shoulder surgery. He said the orthopedic surgeon would be able to estimate the charge for his own work, but shouldn't be asked to estimate what the hospital might charge for the MRI, the radiologist for reading the MRI, the hospital for its operating room and associated costs, or the anesthesiologist for charges in connection with the surgery.
"The surgeon has no ability to provide this information what would be required," Melby said.
Bob Olsen, vice president of the Montana Hospital Association, said his group wants to amend the bill so instead of saying a provider must disclose "the" charges, it would say the provider must provide "its" charges, so he, she or it are responsible for only their respective segment of the charges.
No one spoke against the measures. The House committee took no immediate action.