The list of groups joining the lawsuit is extensive: Ohio Hospital Association, Ohio State Medical Association, Ohio Psychological Association, Ohio Physical Therapy Association, Ohio Chapter of the American Academy of Pediatrics and others.
Mike Abrams, head of the Ohio Hospital Association, says the law is flawed, confusing and would lead to delays in patient care.
Before non-emergency services are rendered, a health care provider would have to give patients written estimates on how much their insurer will be billed for each procedure, test or service, how much their insurers will pay, and calculations for the patients’ out of pocket costs. The hospitals, doctors and others suing the state call it “poorly written, confusing, ambiguous, value and impossible legislation.”
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The health care price transparency provision got folded into the Bureau of Workers’ Compensation budget bill at the last minute in June 2015.
The health care providers complain that sticking it into the BWC bill violates the Ohio Constitution, which requires that bills deal with single subjects and get three public readings before adoption.
The health care groups have been working back channels to try stop the law from going into effect but the lawmaker who sponsored it “has shown little regard for what is about to happen to millions of patients and thousands of providers throughout Ohio,” the lawsuit says.
State Rep. Jim Butler, R-Oakwood Jim Butler candidate Ohio House 41 2016
Butler and state Rep. Terry Johnson, R-McDermott, sponsored a stand-alone bill that called for the price transparency mandate as well as other changes to Ohio Medicaid.
Butler argued in an opinion column published by the Dayton Daily News Ohio Medicaid spending must be overhauled to reduce waste and improve care. Offering price transparency would prompt people to be "more cost conscious when comparing and shopping for medical services," he wrote.
The 25-page complaint paints problematic scenarios for the written estimate requirement:
• What if a woman in labor decides at the last minute she wants an epidural? Would it qualify as an emergency or non-emergency?
• What if the insurance plan doesn’t respond “within a reasonable time” about how much it’ll pay? Should the patient and doctor wait hours or even days on end?
• What happens when services are billed as a daily rate or as part of an agreed upon discounted rate?
• What about emergency room visits that aren’t really emergencies – such as the flu or a sprain? Would those require written cost estimates or be exempt because they’re in the ER?
If the insurance company “takes days and not hours to provide all of the required information, the doctor is faced with the hideous choice of delaying patient care and risking malpractice or providing that care and risk being sued for violating the law, or just not being compensated for services eventually provided,” the lawsuit says.
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The law requires the Ohio Medicaid director to write rules to implement the statute but the director doesn’t have legal authority over private insurance plans, the lawsuit noted.
The law, which runs just six sentences, “is no scalpel that carefully cuts through the thousands of moving parts of this important public policy issue. It is a brutally blunt sledgehammer that breaks things and does not build things.”
Butler countered that the health care lobby is resisting price transparency.
“It is definitely not something that is impossible for them to carry out. They just don’t want to carry it out. That’s the problem,” Butler said.