Physicians, hospitals and health insurers have defeated a proposed state law that would have forced insurers to cover out-of-network physicians' charges consumers incurred at in-network hospitals.

 

However, healthcare industry members say the issue is not dead, and they expect to see legislation addressing the topic next year.

 

Dr. Steven B. Spedale, a member of the Louisiana State Medical Society's Board of Councilors, said a major problem is that hospital patients often don't know who is in their network or what physicians will be treating them.

 

"I have yet to meet a person … who has read their whole insurance book. When you get it, it's so long," Spedale said. "Most of us look at schedule of benefits, but nobody really reads the rest of it."

 

The benefits schedule doesn't actually list the in-network physicians, Spedale said. The healthcare system needs to reach the point where patients know what insurance product they are buying, what it covers, and which doctors are at what hospitals. Once patients have all that information, they can make informed decisions, Spedale said.

 

Insurers, hospitals and physicians need to figure out a way to put together a system that will get that information to consumers when they need it.

 

It's unclear what the best method is to accomplish that.

 

A proposed law would require insurers to post an online database of its in-network radiologists, anesthesiologists, pathologists, neonatologists and emergency medicine doctors, their addresses and business numbers by March 31, 2010. SB 282 has passed the full Senate and the House Insurance Committee with no opposition and appears likely to be adopted as law.

 

However, the bill does not make clear how people without Internet access will be able to get the information.

 

What is clear is that hospitals, physicians and health insurers oppose the solution backed by Insurance Commissioner Jim Donelon.

 

Donelon has said a common practice among hospitals – contracting with a single group of radiologists, anesthesiologists and pathologists – often victimized consumers.

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