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From YouTube: Interim Joint Committee on Banking & Insurance (9-20-22)
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A
A
Welcome
we'll
go
ahead
and
call
to
order
the
third
meeting
of
the
interim
joint
committee
on
Banking
and
insurance
at
this
time.
Madam
Secretary.
Would
you
please
call
the
roll
Senator.
C
Rocky
Adams
Senator
Alvarado
here
Senator
Douglas,
senator
girdler
Senator
Howell,
Senator,
McGarvey,
Center,
parrot,
Center
schickel,
Senator,
Smith,
Center,
storm
representative
Bentley
representative
Fisher,
here
representative
Flannery,
representative
Frazier,
Gordon,
representative
gooch,
representative
Hatton,
representative
Kirk
McCormick
here,
representative
Koenig,
representative
Cole,
Carney,
representative
Lewis,
Here,
representative
Lockett,
here,
representative
McPherson,
representative
Meredith,
representative
Pollock,
representative
Roberts,
representative
Santoro,
representative
Smith,
representative
Stevenson,
representative
Upchurch,
representative
Westrom,
co-chair
Carpenter,
co-chair
Roland.
President.
A
And
for
a
very
large
committee,
we
do
have
a
quorum
this
morning,
so
I
would
ask
for
approval
of
the
June,
2nd
2022
interim
second
minutes,
as
well
as
the
August
25th
2022
minutes.
I
have
a
motion
and
I
have
a
second
all
in
favor
right
and
the
minutes
are
approved.
Do
we
have
any
member
who
would
like
to
recognize
anyone
in
the
room
or
have
any
comments
this
morning
before
we
get
started?
A
D
Thank
you,
members
of
the
interim
Banking
and
insurance
committee.
D
So
the
has
a
proud
to
say
that
I
am
a
cancer
survivor
now
and
going
through
that
experience.
I
wanted
to
try
to
do
something
meaningful
to
help
people
that
that
have
went
through
the
men
Afflicted
with
cancer
and
went
through
chemotherapy
like
I
did,
and
this
topic
has
come
to
my
attention.
It's
a
it's
a
policy
initiative
that
has
been
advanced
in
in
our
sister
States.
It's
nothing
new
to
Kentucky.
D
I
filed
a
bill
towards
the
end
of
last
session
on
this
topic
plan
to
make
changes
to
it
when
I
followed
again
this
upcoming
session,
but
it's
an
important
topic
that
I
think
we
can
do
very
cheaply
to
help
cancer
patients
that
want
to
be
parents
have
that
opportunity,
hopefully
one
day,
but
it
is
sperm
and
egg
preservation
for
cancer
patients
I'm,
you
know
I,
know
I'm
sure
some
of
you
all
have
had
family
members
go
through
this
and
your
mind
is
really
you
know,
wandering
when
you
are
approaching
your
treatment
and
I
really
feel
like.
D
This
is
something
that
we
can
do
to
create
Better
Health
outcomes
to
encourage
people
to
start
the
appropriate
treatment
when
necessary.
The
really
what
you
don't
want
to
have
happen
is
a
patient
postpone
necessary
treatment
because
they're
factoring
in
other
considerations
like
you
know,
I
want
to
have
children
one
day.
You
know
what
can
I
do
to
preserve.
D
You
know
my
you
know
my
sperm
or
my
eggs
or
as
I've
learned,
o
o
side
is
a
another
biological
term.
I
know.
Dr
Alvarado
can
probably
correct
me
if
I'm
misusing
some
of
these
biological
terms,
but
this
is
something
that
we
can
do
to
give
people
the
opportunity.
I.
Think
if
you
were
honest
on
this
committee,
that
people
that
that
do
have
children
would
probably
say
that
those
are
that's
the
most
important
thing
in
their
life
and
for
you
all
that
are
grandparents.
D
D
This
does
get
somewhat
complicated
when
you're
dealing
with
insurance
companies
and
and
health
plans
and
certain
coverage
issues,
but
this
is
something
that
I
think
that
we
can
do
that.
That
is
very
cheaply
to
really
be
a
benefit
to
cancer
patients
and
and
give
them
the
opportunity
to
hopefully
have
a
family
of
their
own
one
day.
D
E
There
we
go
good
morning.
First
off
I
would
like
to
thank
representative
Flannery
for
raising
Awareness
on
this
important
issue.
I
would
also
like
to
thank
this
committee
for
putting
this
topic
on
the
agenda
so
who
needs
fertility
preservation.
160
000
cancer
patients
will
be
diagnosed
with
cancer
this
year
during
their
reproductive
years.
Cancer
treatment
is
both
treatment-based,
systemic
and
multifactorial.
E
Chemotherapy,
radiation
and
surgery
can
all
cause
infertility,
either
directly
or
indirectly,
but
cancer
patients
are
not
the
only
ones
at
risk.
Patients
suffering
from
autoimmune
diseases,
those
undergoing
surgery
like
hysterectomies,
as
well
as
patients
being
screened
for
hereditary
diseases,
so
this
is
Carly.
Carly
was
diagnosed
with
cancer
at
the
age
of
23..
Unfortunately,
her
insurance
did
not
cover
fertility
preservation.
E
So
I
guess
the
real
question
is:
do
patients
want
fertility
preservation
and
not
all
of
them
do?
But
many
many
would
like
to
be
afforded
the
option.
Patients
desire,
Parenthood
survivors,
Express,
a
desire
to
have
children
and
place
an
increased
value
on
Parenthood
as
a
result
of
their
experience
with
cancer.
They
also
prefer
biological
children
compared
to
third-party
reproductive
options
and
adoption.
E
E
E
Fertility
preservation,
legislative
summary:
you
can
see
from
this
map
that
33
States,
including
DC,
have
introduced
legislation.
11,
have
enacted
and
passed
fertility
preservation
coverage
again,
it's
quite
varied
across
the
country.
If
anybody
has
any
specific
questions,
we
can
discuss
it
later,
but
I'm
not
going
to
read
you
this
entire
spreadsheet.
E
So
what
are
the
rationales
for
coverage?
One
fertility
preservation
is
medically
necessary.
Two
treatments
are
standard
of
care.
Three
promotes
better
medical
outcomes;
four,
it
is
low
cost
and
potential
cost
offsets
and
five.
There
is
an
ethical
basis
for
coverage.
We're
going
to
dig
a
little
deeper
into
three
and
four
just
to
be
sensitive
to
time,
so
promotes
better
medical
outcomes.
E
E
E
For
example,
fertility
concerns
negatively
affected
tamoxifen
initiation
and
urine.
Tamoxifen
is
a
drug
used
in
patients
diagnosed
with
breast
cancer
and
premenopausal
women
have
had
concerns
that
the
tamoxifen
would
impact
their
ability
to
have
children
and
another
third
said
it
influenced
their
treatment
options.
E
It
also
doesn't
cost
that
much
in
the
grand
scheme
of
things
for
providers,
it's
very
low
pennies
for
patients,
it's
high
extremely
expensive
for
an
individual
patient,
especially
females
to
afford
fertility
preservation.
The
urgency
exacerbates
the
cost
and
the
patients
facing
additional
cost
of
Cancer
Care
in
terms
of
offsets.
There's
reduced
distress,
high
cost
incurred
if
less
effective
treatment
leads
to
more
disease
and
then
really
quantifying
the
value
of
future
lives
and
Parenthood.
E
He
had
his
sperm
Frozen
did
not
have
any
coverage,
so
he
had
to
pay
The
Upfront
cost,
which
was
750
for
his
first
year
of
coverage
and
then
another
300
annually
thereafter.
Fortunately,
Tom
was
able
to
afford
this
and
their
family
said
welcome
to
new
baby
in
June,
and
that
is
all
I
have
for
you.
Thank
you.
A
D
Don't
believe
that
I
did,
however,
there
was
a
similar
bill.
My
research
on
this
indicates
that
in
2018
it
was
Senate
Bill
95.
It
was
filed
by
Senator
Kerr.
It
did
pass
the
Senate
34-3
and
based
on
the
documents
associated
with
that
bill,
it
appeared
that
it
was
zero
to
four
cents
per
month
as
to
what
the
cost
would
be
on
this
and
and
that's
been
confirmed
with
lrc
staff,
as
well
as
to
the
accuracy
on
that.
But
those
are
that's.
That's
the
numbers
that
I
have.
A
F
Thank
you,
representative
Flannery,
and
you
know
seeing
firsthand
what
all
you
went
through
last
year
and
what
you
know,
people
affected
by
cancer
goes
through
and,
and
you
know
to
be
honest-
I
hadn't
really
thought
about
this
side
of
the
issue.
Before
my
question
pertains
to
the
last
slide
under
Tom
W,
the
Hodgkin's
lymphoma
and
Lymphoma,
he
mentions
that
the
annual
cost
is
about
300
for
continual
storage.
D
And
I
will
say
that
the
the
storage
cost
is
there
is
a
difference
between
I
guess.
The
method
of
whether
there's
a
harvesting
of
the
egg
or
you
know,
can
be
a
difference
on
I
guess
how
that
you
know
sample
can
be
given,
but
the
storage
cost
for
my
understanding
and
then
and
I.
Don't
want
to
really
be
quoted
on
this,
but
I.
G
Thank
you
Mr
chairman,
and
thank
you
all.
This
is
important
and
I
know.
Like
I
said,
like
you
had
mentioned,
representative
finery,
we
looked
at
this
in
the
Senate
and
gotten
it
through
at
one
point
and
the
big
the
big
question
I've
got
really
is
it
has
to
do
with
really
what
representative
Lucius
talked
about
was
the
storage.
G
G
Does
someone
you
know,
maintain
ownership
of
this?
That's
always
a
question.
Whatever
we've
had
bills
that
requires
anything
that
might
have
DNA
of
any
sort.
It's
always
been
a
discussion.
I
know
in
the
Senate
has
always
been
about.
You
know
what
happens
to
that
material
later,
who
owns
it,
who
disposes
of
it
Etc?
So
maybe,
if
you
could
speak
to
that
as
to
what
occurs
once
that's
donated,
if
somebody
doesn't
maintain
for
storage,
it's
just
discarded
is
there
if
someone
passes
away?
E
D
D
You
know
maybe
they're,
not
maybe
they're
not
married,
maybe
they're,
not
it's
not
really
the
time
for
them
to
have
children
compared
to
someone
that,
maybe
you
know
in
their
late
30s
recently
married
and
they
don't
have
children,
so
I
think
it's
important.
We
want
to
really
try
to
find
the
like
the
right
duration
dealing
with
the
age
and
really
what
their
situation
is.
D
You
can
also
have
a
patient
in
their
late
teens
that
you
know
marriage,
maybe
you
know
decade
away
or
longer,
and
how
long
are
we
gonna
have
to
cover
that
before
that
person
is
ready
for
Parenthood.
G
G
Is
it
just
a
matter
of
if
they're
still
fertile
and
still
willing,
so
there
might
be,
let's
say,
I,
think
of
a
woman,
maybe
in
her
early
40s,
who
are
still
able,
but
you
know,
maybe
you
have
a
Cancer
and
saying
well
I'd
like
to
do
this
as
a
preservation,
because
I
might
want
to
do
something
in
the
future
or
have
a
surrogate
or
whatever
you
know
the
different
situations.
Is
there
a
recommended
cut
off?
Do
the
medical
association
speak
to
that,
or
is
it
just
still
open-ended
in
a
lot
of
states.
D
They're
I
can't
fully
answer
that,
but
I
will
say
talking
to
the
bill
drafter
and
lrc
staff
there.
There
are
some
I
guess:
hurdles
dealing
with
some
of
that
dealing
with
I,
guess,
ageism,
discrimination
and
and
certain
factors
so
I
think
that's
your
question
is
something
that
is
going
to
have
to
be.
You
know
dealt
with
and
those
are
going
to
be
some
it's
going
to
have
to
be
addressed.
H
Representative,
thank
you
very
much
for
bringing
awareness
to
this
issue.
I
commend
you
on
bringing
this
forward.
I
come
from
an
area
where
we
have
a
30
percent
higher
cancer
rate
than
the
national
average,
and
for
anyone
that
knows
much
about
cancer,
we're
seeing
it
in
a
much
much
younger
age,
group
and
I.
Don't
know
that
any
of
us
can
escape
it
in
this
life,
but
it's
an
excellent
idea.
H
The
preservation
of
this
DNA
or
the
eggs,
the
sperm
Etc
one
thing
I
would
like
for
you
in
your
bill,
if
you,
if
it
can
be
done,
is
to
include
the
cost
of
the
storage
and
it
it's.
You
know
we
deal
with
a
lot
of
people
who
don't
have
insurance
and
those
are
people
who
are
with
insurance
that
can
afford
to
do.
It
is
usually
the
working
class,
the
upper
middle
class.
So
this
is
an
excellent
plan
and
I
hope
you
see
it
through.
I
Flannery,
can
you
kind
of
clear
something
up
in
my
mind,
because
it'll
probably
be
January
before
we
start
dealing
with
this
again?
Are
we
talking
about
already
diagnosed
or
pre-diagnosed
on
doing
this?
You
know
doing
this
process
when
you
find
out,
you
have
cancer.
Is
this
the
then
you
start
looking
for
doing
this,
or
can
you
kind
of
clarify
when,
when
this
would
take
place
or.
D
I
mean
ideally
it's
pre-treatment.
You
want
to
do
the
preservation
prior
to
chemotherapy
or
radiation,
because
that
you
know
that
is
the
treatment
is
what
you
know
can
impact
your
fertility,
so
really
we're
dealing
with
someone
that
has
been
diagnosed
with
cancer.
We've
got
a
diagnosis,
but
they
have
not
started
their
treatment
yet,
and
that
and
that
window
can
be
very
brief.
D
I
mean
I.
Typically
I
would
think
that
you
know
you've
probably
got
anywhere
between
a
maybe
a
week
or
two
and
then
maybe
like
a
month
depending
on
what
type
of
cancer
and
what
type
of
treatment
is
appropriate.
I
mean
really,
depending
on
what
type
of
cancer
you
have.
You
have
will
dictate
the
treatment
I
mean
not
not
all
chemo
and
radiation.
You
know
is
really
the
same.
So
but
it's
it's
all
pre-treatment.
Okay,.
I
D
Is
that
is
part
of
it
and
then,
after
you
have
that
preservation,
there's
a
Affiliated
storage
cost
with
preserving
that
you
know,
for
you,
know,
x,
amount
of
years
down
the
road
depending
upon
what
is
appropriate
for
the
patient
and
and
really
what
what
is
a
biological
reality
for
that
person.
So
a
lot
of
it
would
depend
on
the
age
of
the
patient
and.
I
J
Thank
you,
Mr
chairman
and
I
really
appreciate
you
all.
Bringing
this
bill.
I
actually
had
a
niece
who
passed
away
from
breast
cancer,
and
so
she,
but
she
was
a
Georgia
resident
and
insurance
covered
it
in
Georgia
for
her
to
harvest
her
eggs
before
her
chemo
happened
and
how
the
it
and
I
don't
know
if
this
helps
Dr
Alvarado,
but
how
they
did
it
in
Georgia
is
clearly
The
Possession
went
to
her
husband
after
she
passed,
but
if
there
was
no
activity
in
a
certain
period
of
time,
those
eggs
were
immediately.
J
A
Thank
you
and
thank
you
all
for
for
being
here
this
morning
and
for
bringing
this
topic
to
the
committee's
attention
and
we're
glad
to
have
you.
Cancer,
free
representative,
Flannery.
D
A
The
next
item
on
the
agenda
this
morning
will
be
a
discussion
of
the
federal,
no
surprises
Act.
Our
first
set
of
presenters
this
morning
will
be
Tom
Stevens.
The
executive
director
of
the
Kentucky
Association
of
health
plans
and
I
think
Rusty
Cress
will
join
him
at
the
table
also
and,
of
course,
bring
anybody
else
that
you
have
with
you.
That's
part
of
the
presentation.
A
K
Thank
you,
Mr
chairman
members
of
the
committee.
My
name
is
Tom
Stevens
I'm,
the
executive
director
of
the
Kentucky
Association
of
health
plans
and.
K
So
we're
here
this
morning
to
speak
about
the
no
surprises
act.
The
no
surprises
Act
is
a
component
of
the
consolid,
the
2020
Consolidated
Appropriations
Act,
the
CAA,
as
it's
known,
is
one
of
the
most
significant
mandates
on
the
commercial
Market.
Since
the
Affordable
Care
Act
was
passed
and
May
in
fact,
be
the
largest
piece
of
legislation
ever
passed
by
Congress.
K
So
at
its
most
basic
level,
the
no
surprise
act
prohibits
out-of-network
providers
from
balance
billing,
Commercial
Insurance
members
balance
billing
sometimes
called
surprise.
Billing
is
a
medical
bill
from
a
health
care
provider,
building
a
patient
for
the
difference
between
the
total
cost
of
services
being
charged
and
the
amount
the
insurance
pays.
L
L
Systems
throughout
the
various
States,
the
ahip
supported
the
no
surprises
act,
primarily
because
it
keeps
a
good
check
and
balance
situation
on
balance
billing,
which
end
up
going
toward
the
bottom
line
of
the
consumer
and
kind
of
keeps
the
two
commercial
entities
out
of
it.
I
doubt
that
there's
anyone
in
the
room
that
could
say
they'd
have
never
been
balanced
build,
and
it
is
a
shocker.
L
L
L
So
the
the
whole
purpose
and
Tom's
going
to
go
through
and
painstaking
detail
the
history
and
and
where,
where
we
go
from
here,.
K
So
some
of
the
basic
protections
of
the
no
surprise
Act
prohibit
surprise
bills
for
most
Emergency
Services.
Even
if
prior
authorization
could
not
be
met
or
emergency
resources
were
out
of
network,
it
prohibits
out-of-network,
cost,
sharing,
out-of-network
co-insurance
or
co-payments
for
most
emergency
and
some
non-emergency
services.
K
K
K
There's
significant
patient
education
requirements.
So
this
requires
Health
Care
Facilities
to
furnish
patients
with
a
plain
language
notice,
explaining
the
applicable
billing
protections
who
to
contact
if
they
have
concerns
that
a
provider
or
facility
has
violated
the
protections
and
that
the
patient's
consent
is
required
to
waive
billing
protections.
So
you
must
receive
that
notice
and
consent
to
being
billed
by
an
out-of-network
provider.
K
So
individuals
specifically
covered
Group,
Health
Plans,
individual
health
insurance
issuers
carriers
under
the
federal
employees,
health
benefits
program,
Health,
Care,
Providers
facilities
and,
of
course,
air
ambulance
services,
which
we'll
talk
about
more
later
in
the
presentation,
the
NSA
specifically
doesn't
apply
to
Medicare
Medicaid,
the
IHS
and
Tricare,
because
that's
specifically
banned
as
a
matter
of
federal
law.
So
those
already
recovered.
K
So
specific
Services
subject
to
the
prohibition,
non-emergency
services
are
covered
if
they're
provided
by
out-of-network
providers
at
certain
in-network
facilities,
specifically
hospitals,
outpatient
departments
and
critical
access.
Hospitals
in
ambulatory,
surgical,
centers,
emergency
services
and
related
post-stabilization
services
are
covered
if
the
Emergency
Services,
with
respect
to
an
emergency
medical
condition
or
out
of
network
and
provided
at
a
hospital
or
a
freestanding
emergency
department,
and
there's
lots
of
additional
detail
and
stuff
that
we
can
go
and
turn
them
by
Nation.
K
K
So
an
important
component
to
this
is
something
called
the
qualifying
payment
amount,
and
this
is
a
measure
of
locally
negotiated
Market
rates
defined
as
the
median
of
all
contracts
with
participating
providers
in
that
geographic
region
for
the
same
or
similar
item
or
service
consumers.
Cost
sharing
is
determine
based
on
what
the
terms
of
in-network
cost
sharing
are
for
the
plan
in
which
they're
enrolled
under
the
laws
and
regulations.
K
K
Oh
keep
going
so
another
element
of
this
is
the
independent
dispute
resolution
process,
which
you'll
hear
more
about.
Basically,
this
is
where
a
health
insurance
provider
Health
Plan,
receives
a
claim
of
an
out-of-network
provider
attempting
to
issue
a
payment
or
denial
of
payment
to
the
out-of-network
provider.
The
initial
payment
can
end
the
dispute
entirely
or
a
provider
or
facility
believes
they're
entitled
to
a
higher
payment
amount.
They
elect
to
begin
an
open
negotiation
process
effectively.
K
This
is
binding
arbitration,
so
after
30
days
of
open
negotiation
between
the
plan
and
the
provider
facility,
if
a
mutually
agreeable
reimbursement
amount
isn't
determined,
the
party
can
elect
to
pursue
independent
dispute
resolution
and
then
it
goes
into
there's
a
lot
of
details
here,
but
I'll
skip
these
and
let
you
go
Russ
well,.
L
L
This
independent
dispute
resolution
under
the
no
surprises
act
seems
to
be
a
a
bit
more
fair
and
it
should
be
used
sparingly
as
a
backstop
in
unique
circumstances,
but
it
is
a
a
key
component
of
the
ACT.
K
So
factors
that
go
into
the
qpa
median
and
network
rate
for
similar
services
in
the
geographic
area,
subject
to
the
CPI
demonstrations
of
good
faith
efforts
or
the
lack
thereof,
to
reach
an
agreement
on
any
contracted
rates
between
the
parties.
During
the
previous
four
years,
Market
chair
of
the
parties,
patient
Acuity
and
the
level
of
training,
experience
and
quality
of
the
clinician
or
the
teaching
status
case,
mix
and
scope
of
services
offered
by
the
facility.
L
One
thing
that
I
should
add
to
to
From
ahip's
perspective
is
that
study
was
released
or
a
survey
recently
that
in
the
first
months,
first,
two
months
of
2022,
the
acts
IDR
Provisions
prevented
more
than
2
million
potential,
surprise
medical
bills
across
all
commercially
insured
patients.
L
K
Thanks,
so
this
chart
tries
to
lay
out
some
of
how
this
actually
flows
some
comments
here.
As
far
as
the
scope
of
service
Emergency,
Services,
specifically,
air
ambulance
are
included,
although
notably
ground
ambulance
coverage
is
not
non-emergency.
Services
at
in-network
facilities
in
network
facilities
in
scope
include
a
hospital,
outpatient,
Department,
critical
access,
Hospital,
ambulatory,
surgical,
centers
and
pre-standing
emergency
departments
separate
and
distinct
from
hospitals,
and
then
more
on
air
ambulance.
K
Another
aspect
of
the
CAA
and
really
the
no
surprises
Act-
is
the
provider
directory's
Insurance
ID
card
changes,
so
provider
directories
right
now
we're
in
this
era
of
good
faith
compliance
because
the
rules
haven't
been
promulgated
at
the
federal
level,
but
so
it
would
require
updated
online
directories,
verification
every
90
days
of
non-responsive
providers
and
updated
business
notifications
providers
are
to
be
included
in
the
directory
with
name
address,
specialty
and
additional
contact
information,
and
they
have
to
ensure
that
members
who
receive
inaccurate
information
that
a
provider
is
inaccurate
rather
is
in-network,
can
only
be
liable
for
the
in-network
cost
sharing
component.
K
Also
Advanced
explanations
of
benefits
as
another
delayed
rulemaking
area.
This
would
require
plans
to
provide
the
following
information
for
scheduled
Services
upon
receipt
of
a
provider's,
good
faith
estimate,
Network
status
of
the
provider
facility,
contracted
rate
for
the
item
or
service,
or
if
the
provider
facility
is
not
a
participating
provider
facility,
a
description
of
how
the
individual
can
obtain
information
on
providers
and
Facilities.
K
K
K
The
information
contained
here
in
your
materials
is
a
checklist
of
provided
by
ahip
on
implementation
of
the
no
surprises
act
and
its
additional
Regulatory
Compliance
elements
provided
by
ahip
and
is
a
nice
reference
tool.
K
So,
specifically,
a
little
discussion
on
air
ambulance.
So,
of
course
we're
all
aware
area.
Ambulances
are
typically
used
to
transport
patients
from
the
scene
of
an
injury
or
accident
hospitals
or
inter-hospital
transfers,
particularly
in
critical
situation
when
time
is
urgent
or
when
patients
cannot
safely
travel
by
ground.
The
number
of
air
ambulance
transports
while
relatively
low
has
increased,
and
so
there
is
concern
that
we're
seeing
a
shift
toward
for-profit
entities.
K
So
notably,
patients
typically
do
not
have
a
choice
near
ambulance
providers
potentially
leading
to
larger
out-of-pocket
costs
for
privately
insured
or
uninsured
patients.
Air
ambulance
providers
are
not
allowed
to
send
balanced
bills,
pursue
it
to
the
no
surprises
act
when
an
out-of-network
provider
bills
an
individual
for
the
difference
between
the
bill
charge,
the
amount
paid
by
their
planner
insurance,
the
NSA
extends
the
same
protections
to
private
effective.
That
was
retroactive
to
January
1st.
K
So,
as
you
would
expect
with
a
piece
of
legislation,
that's
this
this
large
and
encompassing
there's
a
great
deal
of
litigation.
That's
taking
place
right
now,
as
we
go
through
the
implementation
process
and
we
were
able
to
identify
eight
different
cases
of
some
prominence
raised
by
all
different
manner
of
interest
holders
in
the
Health
Care
System,
notably,
there
is
one
case
out
of
the
eastern
district
of
Kentucky.
That's
pending
right
now
as
well.
So
this
is
something
we'll
hear
a
lot
about
as
we
move
forward
over
the
next
few
years.
A
All
thank
you
for
the
very
detailed
explanation
of
the
no
surprises
act
specifically
to
air
ambulances.
You
know
the
air
ambulance
issue
I
think
was
was
settled
in
Kentucky
prior
to
the
passage
of
this
when,
when
the
carriers
and
the
major
providers
agreed
to
go
in
network
on
their
own
and
I,
appreciate
all
the
work
that
went
around
that,
are
you
all
hearing,
I'm
not
hearing
of
any
issues
in
Kentucky
now
related
to
our
ambulance?
A
L
About
that,
it's
my
understanding
that
it's
it's
it's
it's
it's
it's
helping,
but
you
also
have
private
Equity
firms
that
are
trying
to
get
involved
with
the
ownership
of
of
the
provider
and
and
it
makes
it
a
a
bit
cross-purpose
in
terms
of
providing
care
versus
profit.
So.
K
How
it
goes
of
the
litigation?
That's
that's.
Pending
Mr
chairman,
a
number
of
those
actions
have
been
brought
by
air
ambulance
related
entities,
so
you
have
Phi
Health
the
association
of
air
Medical,
Services
lifenet,
so
you
have
cases
out
of
Kentucky
Texas
and
the
DC
circuit
that
are
all
pending
related
to
air
ambulance
implementation.
Thank.
M
N
N
N
But
the
point
is
on
your
insurance
cards
and
you
guys
brought
it
up.
Why
don't
you
standardize
insurance
cards
in
the
insurance
field
because
everybody
has
their
own
group?
You
know
every
plan
number.
If
they
were
the
same
place
on
every
card
across
the
United
States,
it
would
save
you
all
all
kinds
of
man-hours
and
money.
A
G
A
G
I,
don't
have
that
much
as
much
as
I
think
actually
so
so
Rusty
Tom.
Thank
you
guys
for
being
here
and
thanks
for
the
presentation,
this
looks
pretty
familiar
I
the
way
this
worked
out
on
the
federal
government.
We
worked
on
this
bill
for
at
least
two
and
a
half
years
in
meetings
and
I
was
frankly
surprised.
When
the
feds
came
up
with
a
solution,
because
I
didn't
every
year,
they
talked
about
it
and
it
would
blow
up
each
side.
G
Would
providers
and
insurance
companies
would
fight
on
this
and
it
never
got
and
I
just
didn't,
have
any
faith
that
they
would
get
it
done.
So
the
fact
that
they
got
it
done
was
impressive
and
really
looks
very,
very
familiar
to
what
we
were
proposing
here
in
Kentucky.
It's
not
identical,
but
it's
pretty
darn
close,
so
I
was
really
pleased
to
see
that
a
couple
of
things
I
just
want
to
mention.
G
You
know
when
we
talk
about
the
definition
of
what
balance
billing
is,
and
it's
the
difference
between
the
total
cost
of
services
being
charged
in
the
amount
the
insurance
pays.
I
think
it's
important
for
everyone
to
know
that,
typically
the
amount
that
the
insurance
pays
is
zero.
That's
typically
the
situation
when
this
occurs
is
you
have
a
provider,
that's
out
of
network
and
the
insurance
company
says
you're
at
a
network.
G
It's
not
our
responsibility,
we're
not
going
to
pay,
so
this
solves
a
problem
in
which
people
are
stuck
with
the
entire
charged
amount,
because
the
insurance
company
was
unwilling
to
pay.
That's
where
a
lot
of
this
stemmed
from
and
from
a
lot
of
providers
that
I've
talked
to
that.
That's
important
to
know
it's
not
that
the
insurance
thing
well
we're
willing
to
pay
you.
You
know
100
bucks
for
a
charge
of
200
and
negotiate
the
difference
and
the
provider
says
I'll
charge
you
the
extra
hundred
that
isn't
what
it
typically
occurs.
G
What
typically
occurred
with
this
was
here's
my
bill
for
200
I,
don't
know
who
you
are
I'm,
paying
you
zero
patient,
you
figure
it
out
and
that's
where
they
got
stuck
with
this
situation.
So
I
think
we
might
have
to
make
that
very,
very
clear.
The
second
thing
I
know
we
talked
about
how
many
people
have
been
having
problems
with
this
I
mean
during
the
discussions
we'd
had
for
those
two
and
a
half
years.
There
were
several
members
of
the
insurance,
Lobby
and
others
who
said
this
is
not
a
problem
in
Kentucky.
G
We
don't
have
this,
it's
not
really
a
concern.
It's
not
a
major
issue
and
I
think
your
statistic
clearly
showed
that
it
is
so
I'm
glad
that
this
got
accomplished
and
got
done,
I'm
happy
to
see
the
dispute
resolution
a
portion
of
this,
because
I
think
it
really
helps
a
lot
of
folks
in
that
the
baseball
style.
You
know,
I
think
that
you
talked
about
in
New
York
what
they
did
there
was
we
had
discussed
doing
that
and
I
think
both
sides
didn't
like
it
because
I
think
it
provided
it
was.
G
Basically
this
is
what
I'm
gonna
what
I
want
to
get
paid.
This
is
what
the
insurance
companies
willing
to
get
paid,
and
you
had
an
Umpire
who
said:
I'll
go
with
the
one
that
I
think
is
the
closest
to
what
they
should
get
paid,
and
there
was
no
negotiation
in
the
middle
when
we
talked
about
it,
I
think
both
providers
and
insurance
companies
said
we
don't
like
that.
G
We
want
to
be
able
to
negotiate
it
ourselves,
don't
get
in
the
middle
of
having
it
go
one
way
or
the
other,
and
it
sounds
like
in
New,
York
they're
siding
more
with
providers,
because
that's
why
the
reason
that
the
cost
would
go
up
with
a
lot
of
that
so
that
that
is
all
I'm.
Just
I'm
glad
to
see
this
guy
passed.
I
know,
there's
some
requirements
in
this
bill
also
for
transparencies,
my
understanding
to
require
hospitals
and
others
to
start
posting
what
their
charges
are.
G
Some
of
that's
being
reported,
I
think
it's
in
methods
that
are
very
difficult
to
find
online
and
very
difficult
to
decipher,
based
on
how
it's
being
reported
so
we're
trying
to
to
work
on
a
lot
of
that,
but
but
anyway,
that
that's
the
biggest
the
biggest
takeaways
I
got
in
brilliant
and
I
said.
A
lot
of
this
looked
very
familiar
to
what
we
were
looking
to
do
in
Kentucky,
so
I'm
just
pleased
that
it
got
done
and
it
makes
it
a
consensus
across
the
board
gentlemen.
A
B
Morning,
Mr
chair
and
members
of
the
committee
I'm
Sharon
Clark,
commissioner,
at
the
Kentucky
Department
of
Insurance
I,
really
don't
have
a
lot
to
present.
Today.
You
got
a
good
understanding
of
the
background
of
this
bill,
but
I
will
tell
you
15
years
that
I've
been
with
the
Department
of
Insurance
I.
Think
this
is
the
one
one
of
the
most
significant
bills.
I
agree
with
you
Senator
Alvarado,
to
help
kentuckians
and
yes,
we
have
had
problems
in
the
past.
B
I
I
can
relate
one
to
you
where
elderly
lady
hip
came
out
of
socket.
The
local
EMTs
decided
that,
instead
of
using
a
ground
ambulance,
they
want
to
use
air
ambulance
and
she
got
a
39
000
Bill
afterwards
and
called
the
Department
of
Insurance
to
try
to
find
out
how
we
could
help
her,
and
there
was
nothing
we
could
do,
and
that's
always
difficult
for
us
at
the
department
when
we're
faced
with
consumers
that
are
in
hardship
and
we
can't
help
them.
B
The
other
issue
where
this
comes
up
so
frequently
is
when
you
know
that
policyholder
does
due
diligence.
They
find
out
that
there
are
hospitals
and
network.
They
found
that
their
surgeon
is
in
network
and
then
it
turns
out
the
anesthesiologist
is
not
Network
and
that
patient
could
not
choose
the
anesthesiologist.
Nor
could
they
choose
the
pathologist.
That
is
maybe
looking
at
that
sample.
Nor
can
they
choose
a
radiologist
and
those
are
the
frequent
instances.
B
And
yes,
it
has
been
an
issue
in
Kentucky,
so
I'm
very
happy
that
this
bill's
been
in
pay
us
by
on
the
federal
level.
B
So
the
department
completed
that
at
the
same
time,
CMS
was
asking:
what
is
your
ability
to
enforce
this
over
health
care
providers?
I?
Don't
have
that
ability?
That's
not
in
our
statutes.
It's
not
in
our
regulations
and
I
think
that
CMS
Then
followed
up
with
other
licensing
entities
here
in
Kentucky
Board
of
Professional
Licensing
different
ones.
Again,
they
did
not
have
that
enforcement
capability,
so
in
the
state
is
not
able
to
enforce
this
bill.
The
federal
government
will
enforce
it
so
going
forward.
B
As
you
know,
it's
requiring
the
in-network
cost
sharing
and
we,
as
they
mentioned
in
the
earlier
presentation,
you
know,
there's
transparency,
requirements,
there's
ID
requirements
and
anything
that
has
to
do
with
the
health
insurers.
You
know
that
falls
under
our
bailiwick
and
we'll
be
there
to
do
it
just
like
we
do
every
day
as
it
is
so
promised
you
short
and
sweet,
Mr,
chairman
and
but
again,
I
will
emphasize.
This
is
a
new
law
and
you
heard
Mr
Mr
Stevens
refer
to
rules.
B
Well,
rules
are
the
equivalent
on
federal
level
or
the
equivalent
of
State
administrative
regulations
on
you
know
our
local
level.
So
a
lot
of
these
rules
have
been
interim
and
they're
still
being
developed,
and
it's
new
law
don't
have
hardly
any
data
at
all.
You
asked
the
question
earlier.
I
know
that
the
air
ambulance
issue
has
been
a
significant
one
in
North,
Dakota
has
always
been
out
there,
leading
the
charge
and
I
think
it's
because
of
just
the
small
population
and
how
it
spread
across
the
state.
But
I
just
don't
have
the
data.
B
Yet
we
have
not
received
any
complaints,
but
we're
prepared
when
we
do.
A
Thank
you,
commissioner,
for
being
here
always
appreciate
you
doing
that.
I
do
have
a
question
from
representative
Meredith.
O
Really
more
of
a
comment:
Mr
chairman,
if
I
might
and
I
appreciate
that-
and
commissioner
I
really
appreciate
you
bringing
up
the
the
the
idea
of
non
what
I
would
consider
kind
of
non-direct
services
or
additional
Services
as
a
part
of
medical
planning
and
and
things
of
that
and
not
really
an
insurance
issue.
You
know
I
I
work
in
a
bank
I
check
people's
credit
every
day
for
a
living,
and
one
of
the
things
that
I
hear
from
many
times
is:
there's
a
you
know:
I
pull
their
credit.
O
There's
a
medical
collection
on
their
credit
report,
never
received
a
bill
for
that,
and
you
always
wonder
sometimes
maybe
they're
right.
Sometimes
they
missed.
It
could
be
a
lot
of
different
things.
O
But
my
surprise
came
this
year
when
I
received
a
letter
from
a
collection
agency
on
myself
fairly
recently
and
what
had
happened
was
I
had
had
a
chest
x-ray
back
last
year.
They
thought
I
had
pneumonia
and
the
Radiology
company,
who
read
the
bill
or
read
the
the
X-ray,
had
turned
me
over
to
collection,
I've,
never
heard
of
that
company
didn't
know
anything
about
them.
O
My
direct
provider
has
with
somebody
else
and
and
then
eventually
my
insurance
will
have
something
with
them
too,
and
again,
I'm
able
to
mitigate
go
through
that
pretty
well,
because
I
get
something
like
that.
I
know
where
to
go,
but
how
many
people
wouldn't
know
how
or
have
any
idea
where
to
go
and
when
I
finally
got
the
research
on
it,
it
was
truly,
they
didn't
have
an
address
for
me.
They
didn't
have
a
phone
number
for
me.
They
didn't
have
my
insurance
card,
so
just
turn
him
over
to
collection.
B
So
it
was
a
surprise
bill,
you're
right
in
in
an
instance
like
that
it
certainly
would
have
to
be
the
Attorney
General,
because
we
would
not
have
any
Authority,
but
it's
you're
mirroring
comments
and
I
would
be
surprised
if
you
didn't
have
multiple
people
that
might
have
that
medical,
those
medical
charges
on
their
credit
history
and
it's
due
to
instances
such
as
this.
Thank
you,
representative,
Senator
Alvarado,
just.
G
Real
quick
Mr
chairman
just
on
on
that
representative
Meredith's
comments,
I
mean
I,
think
a
lot
of
what
you're
seeing
now
is
the
corporate
institution
that
Healthcare
has
become
it
used
to
not
be
that
way.
I
think
many
of
us
here
are
old
enough
to
know.
Remember
when
we
could
go
see
a
doc.
The
doc
would
do
his
own
billing.
They
were
independent.
G
Those
days
are
long
gone
and
a
lot
of
that
is
because
we've
driven
providers
into
corporate
structures
into
larger
groups
so
that
you
don't
have
an
independent
radiologist
wanting
to
do
that
x-rays.
They
can't
survive
often
with
insurance
costs
of
their
own
for
malpractice
for
EMR
requirements,
all
the
things
that
have
come
down
from
government
and
from
insurance
companies
on
requirements.
It
makes
it
tougher
for
independent
doctors
to
survive.
So
a
lot
of
Physicians
now
are
driven
into
larger
massive
groups.
You
have
very
few
independent
doctors.
Remaining
I've
got
an
old
partner.
G
Who's
called
me
up
recently
saying:
hey
man,
I'm
I'm
done
with
my
employer.
Let's
go
to
you
know:
let's
go
open
up
a
product,
you
got
you
kidding
me
I
mean
there's
no
way
you
can
survive.
You
can't
just
open
up
a
shingle,
hang
up
a
shingle
and
provide
the
care
that
you
used
to
have
because
of
all
the
requirements.
I,
like
you,
know,
EMR
and
lots
of
things
involved.
The
one
thing,
commissioner
I
want
to
ask
you
really
quickly.
We
heard
the
last
presentation
there
about.
G
You
know
how
some
of
these
providers,
their
for-profit
and
they're,
doing
this
for
money
and
there's
been
a
lot
of
undertones
at
times
at
least
my
discussions.
The
years
that
I've
been
here
that
oh,
it's
still
providers
they're
all
money,
greedy
and
they're
wanting
to
make
money.
Do
we
have
any
non-profit
insurance
companies
for
health
care
insurance
in
this
state
that
you're
aware
of
yes,
sir?
G
No,
no
they're,
all
for-profit
correct
and
often,
if
I
try
to
invite
you
if
we're
going
to
be
worried
about
profitability,
it's
not
something
I've
been
saying
a
lot
of
publicly,
but
at
times
I
have
of
taking
a
look
at
the
top
10
companies
in
this
country
in
profitability.
I
can
assure
you
it's
not
an
air
ambulance,
it's
not
a
medical
practice
somewhere
in
the
state.
It's
not
a
big
Radiology
Group.
G
You
can
all
do
that
research
yourself
and
see
where
some
of
those
top
100
or
top
10
companies,
often
in
this
country,
are
so
I
think
it's
very
important
that
we
take
a
look
at
a
lot
of
people
that
are
doing
things
to
create
a
livelihood.
I
think
the
bill
that's
been
passed,
I
think
strike's
a
good
balance
and
that
it
brings
everybody
to
the
table
and
forces
them
to
the
table
to
have
that
discussion
and
holds
the
patient
harmless,
which
is
ultimately.
G
What
needs
to
happen
here
is
to
keep
Patients
Out
of
the
middle
of
this.
So
the
two
big
groups
that
are
you
know,
trying
to
again
create
a
living
for
themselves,
for
their
shareholders
can
find
a
way
to
get
negotiations
done.
So,
commissioner,
looking
forward
to
seeing
how
this
goes
and
if
you
hear
of
anything
or
issues
that
we
need
to
as
a
state
to
make
our
federal
representation
aware
of
moving
forward,
I'd
appreciate
to
know
that,
because
I
think
again
again
what
they
passed,
I
was
surprised
that
it
got
passed.
G
B
A
Thank
you,
commissioner.
The
final
question
I
believe
this
morning
will
be
from
representative
Frazier
Gordon.
B
M
You
to
be
here,
air
ambulance,
so
with
the
implementation
of
the
no
surprises
act
where
a
patient
cannot
be
balanced
to
build.
Is
there
a
need
for
air
ambulance
subscriptions
anymore,
because
it
seems
if
the
patient
isn't
going
to
get
a
bill
that
they
don't
need
to
buy,
subscription
insurance
anymore.
B
Well,
really,
we
don't
have
any
data
in
yet,
but
personally
I
would
not
see
the
need.
I
On
a
follow-up
on
that
is,
is
there
very
many
people,
that's
forced
into
subscription?
I
I
I
I
And
following
up
with
representative
Merida
I,
don't
know
very
many
people
has
not
been
to
through
medical
that
doesn't
have
problems
with
deals,
I
mean
ever
I've
experienced
it
and
I
know
everybody
has
it's
had
any
kind
of
medical
treatment,
but
this
law
that
you're
talking
about
is
is
actually
new
to
me.
So
I'm
going
to
look
into
how
I
can
have
a
little
bit
of
Leverage
when
they
call.
But
one
thing
that
I
started
doing
on
my
provider
is
I'm
going
now
when
I
sit
down
with
a
provider
I'm
telling
them.
I
If
they
don't
give
me
all
my
bills
and
I'm,
not
paying
anything
else
so
I
make
my
provider
know
up
front
that
whatever
Services
I'm
getting
that
I
want
to
know
that
I'm
going
to
be
receiving
all
the
bills.
You
know
to
know
what
I'm
paying
so
when
I'm
done
I
know,
I'm
done
and
I
can
and
I'm,
like
representative
Meredith
a
year
later
receiving
a
notice.
So
it
is
I'm
hoping
that
this
that
the
senator
is
right,
that
this
is
a
solution
because
it
has
been.
I
It's
brought
up
frequently
to
me
on
on
people
receiving
bills,
and
and
after
a
year
or
two
you
don't
even
realize,
or
you
can't
remember
what
was
taking
place.
Sometimes
so
I
appreciate
your
testimony
today
saying
that
you
feel
like
this
is:
is
a
remedy
and
you
feel
like
it's
going
in
the
right
direction,
but
on
the
on
the
air
ambulance
side,
I
I
have
a
local
and
I
wanted
to
make
sure
that
it
was
understood
that
that
is
a
voluntary
Terry
service
that
you
subscribe
to
that.
I
A
Thank
you.
Thank
you
again,
commissioner,
for
being
here,
I
think
you're
back
again
with
us
next
month.
Our
next
meeting
date
will
be
October.
The
18th
at
10
A.M
right
here
potentially
could
be
our
last
one
of
the
interim.
So
look
forward
to
you
all
being
here
appreciate
the
banking
and
insurance
committee
staff.
They
always
do
a
great
job
of
getting
these
these
meetings
together
and
a
reminder
to
the
members
on
the
committee
that
the
Insurance
Institute
of
Kentucky
is
hosting
a
dinner
tonight
for
us
just
for
the
members
of
this
committee.