Article - April 29, 2008 - Joplin Globe

Missouri: Proposed bill would regulate doctor billing

By The Associated Press

KANSAS CITY, Mo. — A bill before the Missouri House would prohibit doctors from marking up the cost of certain anatomical laboratory work — such as skin biopsies and Pap tests — that are performed by outside laboratories.

The bill, which has been approved by the Senate and is awaiting floor debate in the House, would prohibit what’s known as “pass-through” billing.

That’s when a doctor sends a patient’s test sample to an outside laboratory for analysis. The lab charges the doctor a discounted price for the work, but the doctor bills the patient’s insurance company or the patient a higher amount.

The extra amount is profit for the doctor, and most patients don’t even know what has happened.

“It seems to me that we should protect the patient from being charged (by a doctor) for a service that someone else is doing,” said Rep. Kevin Wilson, R-Neosho, who is sponsoring the bill in the House.

Opponents argue that the bill gets the state involved in pricing decisions that should be left to private practice physicians and could hurt services for some patients, particularly the uninsured.

The bill would require doctors or laboratories that actually perform the anatomical services to send bills directly to insured patients.

Doctors who send the tests to labs could bill uninsured patients for the services but could not increase the charges. The doctors would have to tell the uninsured patients who performed the pathology services and the cost of each service.

Nineteen states have passed bills that either require direct billing or prohibit markup of pathological services. Medicare and Medicaid have already prohibited doctors from marking up the cost of the anatomical laboratory work they don’t perform.

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