Hospitals’ “surprise claims” practices should be severely restricted, a state Senate health policy leader said Wednesday.
The idea is to give people a better idea of whether medical procedures cost them before agreeing to it, to give patients more certainty about whether their care is in- or out-of-network, and to stop new bills from continuing to arrive months or years later.
Supporters say if Senate Bill 316 becomes law, it will at least provide people with more information to make decisions about health care. And ideally, they say, the costs for everyone in the future could be reduced.
“I don’t think there’s any other industry that agrees to pay services in advance that there are no clues as to what the costs are and no clues as to what is fully charged for those services,” Senator R-Alamance said Wednesday.
She added that the bill is “an attempt to shed light on every part of the healthcare system. We start to see where the cost drivers really exist and start to keep those costs down.”
The Senate has passed a similar bill twice in recent years. But in the face of intense lobbying opposition by the hospital industry, both bills went anywhere on the Capitol. The North Carolina Medical Association, which lobbys for the hospital, declined to comment on the new bill Wednesday.
In addition to the various requirements for providing more information to patients prior to the procedure, the bill allows hospitals to send invoices to patients before they can send the patient an itemized bill containing an explanation called “Plain English.”
Approximately 1 in 8 adults in North Carolina I had medical debt Before the state approved the expansion of Medicaid, according to the Health Policy Analysis Group KFF. GOV at the time after North Carolina approved the expansion of Medicaid in 2023. Roy Cooper urged hospitals to allow about $4 billion in medical debt held by low-income North Carolinians. Cooper announced last year that all hospitals in the state are participating.
Based on her experience as a nurse, Sen. Gale Adcock of D-Wake said there are some of the bills that are difficult, if not impossible, for hospital staff to adhere to, but no lawmakers or members of the public opposed the bill on Wednesday.
She proposed further conversations on how to amend the bill to ensure hospitals follow it.
“It provides clarity to move forward and makes sure you can do what you’re trying to do,” Adcock said.
AI claims to reject it
The Senate Health Committee also discussed another bill, but stopped voting on whether to move it forward, which would prohibit health insurance companies from relying heavily on artificial intelligence to deny people’s claims.
Insurance companies can use AI to help review and decide claims, even if Senate Bill 315 becomes law. However, AI prohibits it from being used as the “single basis” of a decision to deny or change someone’s health care services.
“It’s 2025. AI is a fact of life,” said Sen. Benton Saury, R-Johnson. “It’s something that’s used by doctors and health insurance companies and hospitals in the state. That’s inevitable. You’ll come here, but I know I’ve heard that everyone in this room has some issues with health insurance companies across the country.”
UnitedHealthcare, the country’s largest private health insurance company, is facing a class action lawsuit accusing them of using AI to deny the claims of many. Last year, the company’s CEO was shot after he said it was an assassination targeted by police. It is clearly based on the company’s policies and practices.
Sawley said other bills on surprise claims would exempt health insurance staff from not having to enter contact information into certain forms given to clients. He said “We will deal with the aftermath of fears about employee safety after the tragedy that took place a few months ago by the CEO of United Healthcare.”
UnitedHealthcare CEO Brian Thompson was shot and killed in a targeted attack in Manhattan.
The anti-AI bill also makes many other changes to crack down on health insurers’ efforts to deny people’s claims, including prohibiting insurers from retroactively requesting prior permission for certain types of care and using it to issue denials.
The bill also requires that licensed physicians who have experience with the type of drug in question hear an appeal of denial of insurance.
It appears that insurers will prohibit more money to propose a claim by requesting that they be denied by requesting that they seek an “appeal without financial interest or other conflict of interest in the outcome of the appeal.”
Peter Daniel, the head of the health insurance industry, spoke at the meeting to tell lawmakers he is willing to work with the Senate when he moves through Congress.
