California Gov. Jerry Brown recently signed legislation intended to protect
patients from surprise medical bills. AB 72 removes patients from the
reimbursement battle between insurance companies and out-of-network providers.
According to a
2015 survey conducted by the Consumer Reports’ National Research Center, nearly one in four privately insured California patients was hit with
a surprise medical bill in which their health insurance covered less than
expected in the past two years. The same percentage of those surveyed
was charged at an out-of-network rate when they believed a provider was
in their network.
The new law specifically establishes a payment rate for reimbursement of
out-of-network doctors, which is the greater of the average of the health
insurer’s contracted rate or 125 percent of the amount Medicare
reimburses for the same or similar services. It also limits enrollee and
insured cost sharing for these covered services to no more than the cost
sharing required had the services been provided by a contracting health
Given that patients often have difficulty resolving medical billing disputes,
AB 72 creates
an independent dispute resolution process (IDRP) for claims and claim disputes
related to covered services provided at a contracted health facility by
a noncontracting provider. All of the new requirements apply to health
plan contracts and health policies issued, amended, or renewed on or after
July 1, 2017.
The new law is good news for California patients. “When patients
follow the rules of their plan and go to an in-network hospital or other
facility, they should not be hit with a surprise bill of hundreds or thousands
of dollars from an out-of-network doctor they did not meet or ever choose,”
said Anthony Wright, executive director for Health Access California,
a California consumer advocacy group that co-sponsored the bill.
If you or someone you love has fallen victim to medical fraud, don’t
hesitate to contact
a San Diego personal injury attorney at the Law Offices of Robert Vaage
for a free consultation.