California may enact protections against surprise medical bills

By Harris Meyer
August 27, 2016 - Modern Healthcare

California lawmakers are poised to pass a hard-fought bill this week to shield consumers from surprise out-of-network medical bills, despite continuing objections from physician groups.

Under the bipartisan bill, authored by Democratic Assemblyman Rob Bonta, patients who received care in in-network facilities would have to pay only in-network cost sharing. This would apply only to non-emergency care, since emergency physicians in California already are barred from balance-billing patients.

Health plans would pay non-contracting physicians the plan's average contracted rate or 125% of the Medicare rate, whichever is greater. Doctors could appeal that through a binding independent dispute resolution process.

The bill, expected to receive a final vote in the Senate and the Assembly before the legislative session ends Aug. 31, also tightens requirements on health plans to offer adequate provider networks.

Florida enacted a similar law this year, joining New York, while Georgia and other states are studying the issue or considering legislation. A recent Consumers Union survey found that one-quarter of Californians who had hospital visits or surgery in the past two years were charged an out-of-network rate when they thought their provider was in-network.

The California Medical Association is still pushing for tougher network standards, while groups representing plastic surgeons, cardiologists and anesthesiologists oppose the bill. The California Hospital Association and the California Association of Health Plans have not declared a position.

“We hope both insurers and doctors are reluctantly coming to neutrality because there's a sense of inevitability and everyone is tired after two years of intense negotiations,” said Anthony Wright, executive director of Health Access California.