| 3 min read | by Doug Marrin, firstname.lastname@example.org |
State Senator Lana Theis stopped into the Dexter Forum this past Saturday and as per usual was asked, “What’s happening in Lansing?”
When people need medical care, they generally go to healthcare providers that are in their insurance network. While as a patient, we typically select a hospital and lead doctor for planned care that is in our healthcare network. But, we generally don’t choose every member of our care team. Hospitals direct ancillary physicians such as anesthesiologists, radiologists, and emergency room doctors, to play a role in the care that we receive. These providers may be out of our insurance network.
It is possible for patients who receive care from providers outside of their network to receive a “surprise” out-of-network bill. Their insurance company will often pay some amount to the out-of-network provider, but typically less than the provider’s charge for services rendered. In many such cases, the provider then “balance bills” the patient for the difference between their list price and the insurer’s payment even through the patient did not intend to select an out-of-network health care provider.
Senator Theis used the example, “So your Blue Cross contracted rates, just throwing names and numbers out, might have been $1,000 out of a $6,000 bill. Blue Cross pays $1,000. You are personally responsible for the $5,000 difference. There’s nothing out there that says that you’re not, so you need to write that check, or they’re coming after you.”
“We don’t think that’s right,” she continued. “You did everything you possibly could going into that surgery to try to be in-network. The House and the Senate have identical packages that we’re running right now. There’s a lot of competing forces, a lot of interested forces in this that are trying to figure out how to make that fair and reasonable trying to pull the patient out of the middle of it.”
The Senator explained to the Forum that one of the biggest issues is that emergency room physicians are one of the largest groups of non-contracted physicians. You can go into a facility that is in your network but you have no choice in the care you receive because it’s an emergency situation.
“You’re going to end up getting that bill,” said Senator Theis. “So that’s one of the things that we’re trying to address.”
“In my education committee, we’re dealing with merit curriculum right now,” said the Senator. “We’re trying to reorient it so that it’s more reasonable.”
“How many of you are still using your Algebra II class requirement?” she asked. To which the group laughed. “So, ‘financial literacy’ seems like a reasonable alternative to that. We’re trying to make it so that local districts can actually decide for themselves what the best use of some of these requirements are. We’re trying to adjust those to instead of having them dictated down from on high … and maybe the kids actually have some skills that they can use when they get out of school.”
‘Read or Flunk Law’
The question was asked of Senator Theis, “How are we doing with the ‘flunk the third-graders law’?”
The Read by Grade Three law is a law passed by the Michigan Legislature and signed into law in 2016 by then-Governor Snyder. The law went into effect beginning this 2019-20 school year. Under the law, third-grade students will need to achieve a certain reading score on Michigan’s end-of-school-year standardized test, the M-STEP, to advance to fourth grade.
“In my review right now, statewide there are about 1500 kids who are eligible prior to our intervention,” said Senator Theis. “So it’s not the everybody’s gonna flunk, and so I get I get frustrated with this.”
“Are we actually going to try to promote everybody regardless of their ability,” she added. “Are we actually going to require them to know something before we move them on? We have some real frustration with kids that are graduating that are illiterate. That’s not where we should be.”
“What I wanted us to do,” the Senator explained, “is that we didn’t put immediate effect on it, but that we waited until the kids who were in kindergarten moved up into third grade so that everything that we were applying on them once they were in third grade, they had the opportunity for all of those interventions, from kindergarten all the way up to third.”
“I wanted us to be able to put some real pressure on our parents too because there are a lot of parents that are completely disengaged,” she added. “The school needs to babysit. The school needs to do this. The school needs to do that. They’re not paying any attention. But as soon as they start to think that their kids going to be retained, now they’re starting to pay a little bit more attention.”
Senator Theis went on to tell of groups that are coming forward to help students read and how she is hearing from educators how this law is really helping.