Kentucky Surprise Medical Billing – Denton Law Firm

Kentucky’s Potential New Law

on Surprise Medical Billing


In an ideal world, no one would experience the heart-gripping fear of a medical emergency. In this world, no one should experience the same over receiving a surprise bill for that emergency room visit.

For many, even following the instructions of their insurance policies to the letter has landed them deep in debt. They went to a hospital within their insurance network, trusting that their treatment was paid for. They didn’t put their surgery on hold to check whether the surgeon, anesthesiologist, nurses, and anyone else on the surgical team were all in-network, because who would? Then the bills came in, and a surgery that should have been covered by insurance cost hundreds or thousands more dollars, in the name of paying the out-of-network personnel who were in the room while the patient was under.

The Kentucky Senate has introduced a bill, Senate Bill 24, to fix the problem of surprise medical billing. If it passes into law as it is currently written, these will be the primary changes that take place:

    1. All health benefit plans will cover non-emergency health care services by out-of-network health care providers at in-network hospitals and other facilities. You won’t have to worry about which network the doctor treating you is in, so long as you’re at an in-network hospital.
    2. Out-of-network providers will not be allowed to collect any payments from a covered person for covered services. No more surprise bills.
    3. Out-of-network providers will be reimbursed for providing services covered by a patient’s insurance. In other words, you won’t have to worry about those out-of-network providers getting paid.
    4. Insurers will require any provider contracts with in-network facilities to accept the in-network rate as full payment. So, if you’re at an in-network hospital, the hospital will accept your in-network rate, and you won’t have to pay any more than that.
    5. Insurers will not be allowed to charge the covered person beyond that person’s in-network cost sharing (e.g., coinsurance, deductibles, co-payments, and out-of-pocket expenses—what you owe normally to your in-network insurer). You won’t be given a different price just because the doctor who treated you is outside your network.
    6. Insurers offering health benefit plans will cover emergency medical conditions, and will pay for emergency screenings and stabilizing patients. Furthermore, out-of-network providers won’t be allowed to demand more payment for treating you during your emergency. In short, you will get treatment during an emergency, your insurer will take care of the cost to screen or stabilize you, and further treatment will be covered at your in-network rate.

Sound good? Well, as of June 5th, 2019, the bill to enact these changes is in a Senate committee, where it will be revised before being returned to the Senate for a vote. That means now is the time to contact the Kentucky legislature and let them know your thoughts on the bill, whether you want to help get it passed or changed.

For more information on the specifics of the bill, it may be found by reference number 19RS SB 24 or by bill request number 477.

Written by Kristi Street