California puts curbs on surprise medical bills

CRO_Health_CROH_July_Medical_Bill_05-15Surprise! California lawmakers waited until the very end of their legislative session before joining an increasing number of states in protecting patients from unexpected out-of-network medical charges. As many as 70 percent of patients staggered by these often hefty bills say they didn’t know they were receiving out-of-network care when it was given.

Gov. Jerry Brown is expected to approve the surprise medical bill legislation, which was bitterly opposed by providers. The measure won bipartisan support in providing that “patients who received care in in-network facilities would have to pay only in-network cost sharing” and only in instances of non-emergency care. As the industry publication Modern Healthcare describes it:

Emergency physicians in California already are barred from balance billing patients. The bill’s provisions [do not apply] to self-insured employer health plans, which are shielded from state regulations by the federal Employee Retirement Income Security Act. 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, which the state Department of Managed Health Care will establish.

New York and Florida already have passed prohibitions on surprise medical bills, and as the Consumers Union notes, more states are considering legislation or improved measures.

Americans’ outrage over out-of-network charges has risen, even as the numbers of the insured has climbed under the Affordable Care Act. Although more patients have gained coverage, medical costs still can be prohibitive for individuals and families with finances already stretched thin, and the sudden weight of a hefty and surprise medical bill can topple many already precarious patients into bankruptcy, with or without insurance, as I have written before.

Insurers also have made networks and their charges even more vexatious for patient-consumers: To keep their costs down, insurers have forced millions of Americans into “narrow” networks, which often lack robust choices for specialists and specialized care as offered at pricier, large hospitals and academic medical centers.

I’ve written before about how patient-consumers can battle their insurers when coverage gets denied, and there are online resources with suggestions about dealing with surprise bills for out-of-network costs.

And while I’m pleased to see state lawmakers step up to assist voters against the avarice that seems almost baked into the health care system, more needs to be done still to ensure Americans access to quality, affordable, and safe medical services. With health care spending accounting for almost 18 percent of the nation’s Gross Domestic Product, it isn’t as if there’s a lack of money to go around for those providing services in the system. It’s simply scandalous the debt that patient-consumers can rack up to have acceptable well-being or good health, and every reasonable measure to stop painful medical bill surprises is worth a close look.

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