Craig Syata, right, of the Hospital Association of Rhode Island, listens to debate on the House floor on a bill that would make insurers responsible for collecting copays. At left is lobbyist Kelly Sheridan.

The Providence Journal / Connie GroschConnie Grosch

PROVIDENCE — If you have insurance that requires a copay for hospital visits, most likely you’re asked to pay the copay while you’re at the hospital.

An effort by lawmakers to shift the burden from hospitals to insurers — so you would get a bill in the mail instead, and the insurer would be left holding the bag if you didn’t pay — drew strong opposition from the state’s largest health insurers.

So yesterday, the House approved compromise legislation that shifts the bill to insurers after hospitals have made “reasonable collection efforts.”

Rep. Peter L. Lewiss said he submitted the original bill at the request of the chief executive of Westerly Hospital. The bill applies to deductibles as well as copays, and Lewiss said that is where the problem comes in. Lewiss, D-Westerly, said that as more people subscribe to high-deductible health plans, more people are unable to pay their hospital bills, causing extra strain on already financially challenged hospitals.

Rep. Donna M. Walsh voiced fears that some hospitals’ budgets are stretched dangerously thin. “We cannot afford to lose our community hospitals in our area,” Walsh, D-Charlestown, said. “That’s all we have.”

Lawmakers who voted against the bill said forcing insurers to assume responsibility for some portion of unpaid bills would drive up insurance premiums for everyone. “Eventually, the taxpayer is going to pay for this,” said Rep. Stephen R. Ucci, D-Johnston.

Rep. Steven M. Costantino, D-Providence, said he has sponsored similar legislation in the past. Costantino said he faults insurers for selling policies with deductibles so high that insurers “know they cannot be collected.”

Hospitals should not have to pay the price for that, Costantino said. “Hospitals, by federal law… are obligated to treat,” he said. “They have no choice. They treat. And then the chase is on” to collect payment.

Under Lewiss’ bill, hospitals would first attempt to collect all copays and deductibles they’re owed. If the hospital isn’t able to collect the debt within 120 days, it would send the insurer a bill.

But the bill spreads out the cost between hospitals and insurers: the insurer would only pay the hospital 80 percent of the debt amount.

The measure would only apply to bills over $75. Anything less, Lewiss said, wouldn’t be worth the cost of collection efforts on the part of the hospital or the insurer.

The bill also excludes some significant categories. It does not apply to anyone who has insurance through a self-insured entity. That means most public employees and employees of large companies would be exempt, and hospitals would not be able to forward their unpaid bills to Blue Cross or UnitedHealthcare of New England, even if Blue Cross or United administers the plan.

“The legislative process is the art of compromise,” Hospital Association of Rhode Island president Edward J. Quinlan said yesterday. The bill represents a “significant concession” on the part of the state’s hospitals, he said. But, he said, “It’s sharing a responsibility which presently is not shared.”

The assessment from Brian Jordan, the lobbyist for Blue Cross & Blue Shield of Rhode Island, was less rosy. “We don’t like it,” he said.

Jordan said the bill would affect premiums, but “too many unknowns” exist to say how large the effect will be.

Jordan said that only Westerly Hospital was directly involved in negotiations on this bill, and the insurers have no knowledge about how serious other hospitals’ collection efforts are. “This decision is being made in a vacuum,” he said.

The bill now goes to the Senate for consideration.

egudrais@projo.com