Jamie Hansen might be on record for one of the shortest round trips from Clark County to Canada.
The 53-year-old La Center resident in July drove 10 hours to Canada, grabbed her son Ryan from band camp, and then left the next day. Ryan, 15, was experiencing bad hip pain and labored breathing. He was having trouble just moving around. Hansen already had passports ready from a previous trip.
“When I’m crossing the border, it was funny because they’re like, ‘What are you here for?’ I’m like, ‘I’m here to pick up my son.’ ‘How long will you stay?’ ‘A couple hours. I’ll be back through tomorrow morning,’ ” Hansen joked.
The drive to Canada was just the beginning of a longer, more involved and potentially cripplingly expensive medical surprise. Ryan would get care and recover from what were infections. But it turned out the care wasn’t covered by Hansen’s insurance. The family would later be hit with a nearly $100,000 medical bill for what amounted to about a weeklong stay in the hospital, with four days in a pediatric intensive care unit.
What happened to Jamie Hansen is referred to as “balance billing,” when a patient is saddled with costs from an out-of-network provider or facility that isn’t fully reimbursed by their insurance company. Situations like Hansen’s have caught the attention of Washington Insurance Commissioner Mike Kreidler, who has proposed legislation aimed at stopping the practice.
The legislation, House Bill 1065, would require insurance companies to cover emergency, as well as surgical or ancillary services from out-of-network providers accessed by patients in emergency situations or when they are left with few options.
Legislation intended to address balance billing was introduced in the 2018 legislative session, but it stalled after running into opposition from industry stakeholders. A year later, more states have passed bills banning balance billing. Washington lawmakers could be poised to also prohibit the practice.
During a hearing on HB 1065 held Wednesday by the Washington House Health Care and Wellness Committee, Jane Beyer, senior health policy adviser for the Office of the Insurance Commissioner, said that the problem of balance billing is widespread. She cited national studies finding that 20 percent of in-network hospital emergency department visits involve an out-of-network physician and the potential for a patient to receive a balance bill.
She said that the Office of the Insurance Commissioner receives numerous consumer complaints about the practice, and the intent of the legislation is to take consumers out from in between billing disputes between insurers and providers.
“I think all of us would agree that it is unrealistic to expect a consumer who has walked into a hospital or been brought into a hospital, whether for an emergency procedure or even for a planned procedure, to know that the pathologist, the radiologist, the anesthesiologist may not be in their health plan network,” she said.
Beyer said that 11 states have enacted similar legislation. She also said that the Commonwealth Fund, an health care think tank, issued a study on criteria on legislation prohibiting balance billing that it considers comprehensive. She said that the bill meets the study’s criteria.
The legislation requires insurance companies to make payments to out-of-network providers. She said that last year’s legislation was stalled on the issue of what formula to use for payment of out-of-network providers. She said that the current bill limits the out-of-network payment to a “commercially reasonable amount” and directs unsettled disputes between an insurer and providers to arbitration.
During the hearing, representatives from the Association of Washington Healthcare Plans, Premera Blue Cross, Regence BlueShield, Washington State Medical Association and the Washington State Hospital Association indicated that they recognized that balance billing is a problem that they wanted to address. But several expressed some concerns about the details of the legislation.
Rep. Eileen Cody, the Seattle Democrat who chairs the committee, said she took it as a sign of progress that the industry stakeholders had signed in as “other” rather than “con” when speaking to the committee about the bill.
Representatives from the Washington State Nurses Association and SEIU Healthcare 1199NW said they supported the legislation.
Hansen was also present to share her story.
‘Would have wiped me out’
When the Hansens returned to La Center from Canada, they visited The Vancouver Clinic off 87th Avenue and then PeaceHealth Southwest Medical Center before being directed to Randall Children’s Hospital at Legacy Emanuel in Portland to get Ryan proper care.
“I was just worried about what was going to happen next,” Ryan said, mentioning that it was hard to walk.
“I was a little freaked out,” Jamie Hansen added.
Hansen also worried because her LifeWise Health Plan of Washington wasn’t part of the Randall network. She was told it would be OK because Ryan would be an emergency admit. Ryan stayed there for about a week, saw a handful of doctors and specialists, and the family received around a $112,000 bill for the Legacy hospital stay a couple of months later. LifeWise paid about $15,000 of that, and the Hansens were left with nearly $97,000 to pay.
Hansen is a single mom who retired from a job in health insurance in 2004. Her husband and Ryan’s dad, Rob, died in 2015 from cancer at age 58. Rob worked as an emergency services dispatcher with the Portland Police Bureau, and they receive some Social Security survivor benefits now. But Hansen’s benefits run out when Ryan turns 16, which will be soon, and she likes to direct Ryan’s benefits toward his future opportunities, like his college fund.
“I didn’t want to tap into that, either,” Hansen said. “I didn’t think that was right. That was for him.”
Hansen considered selling her house, but she already has two mortgages on it, so she said that approach wouldn’t have made financial sense. She took out the second mortgage to help pay off medical expenses from her late husband’s cancer treatment and her own breast cancer treatment, which she was diagnosed with in 2015.
There were payment plans, too, but Hansen said the best one required more than $1,600 each month over five years, which was too steep for her.
After Hansen convinced Legacy that she legitimately couldn’t afford the bill, they eventually reduced it to about $24,000, with another $14,000 bill still left for doctors and speciality services. Hansen rolled that $38,000 into the second mortgage, and can afford to pay it off on the longer time period.
“It’s a hardship, even for someone who has good insurance and has a comfortable income,” Hansen said. “It still would have wiped me out if the hospital wasn’t willing to negotiate.”