Measure to Prevent ‘Surprise’ Medical Bills Heads to Gov. Brown

Surprise medical bills happen when patients seek care from a facility within their health insurance network but then unknowingly receive services from an out-of-network provider, such as an anesthesiologist, who’s not covered by their insurance.

AB 72, authored by Assemblyman Rob Bonta (D-Oakland) and five colleagues, would protect consumers who end up in that situation from getting stuck with the higher out-of-network bill.

Under the legislation, the consumer would owe a noncontracting provider no more than the in-network cost-sharing amount for the same service.

The consumer’s insurer would have to reimburse the out-of-network provider at either 125 percent of what Medicare would pay for the same service, or the insurer’s average contracted rate for the service, whichever is greater.

The measure is a compromise version of a similar bill, AB 533, which fell three votes shy of passage last year.

The California Labor Federation and Health Access California co-sponsored AB 72. Supporters include Anthem Blue Cross and Blue Shield of California.

A number of medical specialty associations, including the American College of Surgeons, the California Orthopaedic Association and the American Society of Plastic Surgeons, oppose the measure.

A 2015 Consumers Union survey found nearly one in four privately insured Californians who were hospitalized or had surgery were charged an out-of-network rate when they believed the provider was in-network.

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