Legislation that would offer Californians protection against "surprise" medical bills has cleared both state houses and is on its way to Gov. Jerry 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 six 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.