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Surprise medical bills need to stop

 

Date: June 23, 2016
Source: East Bay Times Editorial
Author:   

 

California should join New York and Florida in shielding patients from surprise out-of-network medical bills experienced by more than 20 percent of patients who have ER visits, surgeries or hospitalizations.

The practice can cost patients thousands of dollars and has sent some into bankruptcy. If you've experienced the shock, you'll agree this has to stop.

Out-of-network bills occur when hospitals or treating physicians use medical professionals not in the patient's network for special services, sometimes without patients' knowledge.

When Alameda Assemblyman Rob Bonta first tried to fix this last year, his proposal went down in flames when the California Medical Association refused to back it. The AMA said it would pay health insurers too much at the expense of doctors.

Bonta is back with a bipartisan compromise bill, AB 72, that strives to both protect consumers and be more fair to doctors. It deserves the Legislature's support and the governor's signature.

Under the bill, patients going to an in-network facility would not be subject to bills for treatment from out-of-network doctors, such as anesthesiologists or radiologists.

Insurers would instead reimburse the out-of-network docs at a rate equal to 125 percent of Medicare or the insurer's average contracted rate, whichever is greater.

The legislation is co-authored by Susan Bonilla, D-Concord; Lorena Gonzalez, D-San Diego; Jim Wood, D-Healdsburg; Brian Dahle, R-Bieber and Brian Maienschein, R-San Diego.

Unexpected medical bills have become a hot-button issue across the nation.

Since New York became the first state to pass a similar law, the New York state Department of Financial Services is reporting a sharp reduction in the thousands of complaints from patients the agency had handled in previous years.

In 2011, the department had discovered that the average out-of-network bill for an ER visit was more than $7,000, with insurers generally paying less than half of the costs. This left patients on the hook for the remainder, when they thought their insurance would cover all or most of it.

Florida Gov. Rick Scott signed a bipartisan bill into law in April. Georgia, Hawaii, Missouri, New Jersey and Pennsylvania are considering similar legislation.

Despite the rare display of bipartisan support, Bonta is still expecting the legislation to face a stiff challenge when it goes before its first committee test next week.

The health insurance billing process is so complex that patients often have a difficult time keeping track of what their costs will be, especially during stressful emergency or surgical procedures. They can carefully choose the facility and the treating physician from their insurer's approved network and still be blindsided.

Consumer activists, medical professionals and health insurers need to work with the Legislature on a fair compromise.