The California State Assembly passed AB 1611 by Assemblymember David Chiu and Senator Scott Wiener to end surprise emergency room bills on a 48-9 vote. AB 1611 is a key patient protection that would also lower the costs of health care for California consumers. The bill faced opposition from industry lobbyists who argued that the status quo is working fine, but the patients who receive hospital ER bills of tens of thousands of dollars tell a different story. AB 1611 also gained an endorsement from the Los Angeles Times.
After an emergency room visit, some California patients still receive a “balance bill” which is the difference between what the hospital charged for the service and what the insurer paid for the service. These unexpected medical bills can be huge, even after the patient’s insurance pays their portion. When experiencing an emergency, Californians are not able to choose where they are taken for their care. AB 1611 prevents patients from being on the hook for a bill incurred when receiving care at an emergency room in a hospital that ends up being out of network.
For the majority of consumers, California law requires a health plan to cover the cost of the emergency care a patient receives whether or not a hospital is in-network. However, there is still a giant gap in state law. Specifically, six million Californians with federally regulated health plans and one million Californians with coverage regulated by the California Department of Insurance are at risk for surprise emergency room bills because they are not covered by these important consumer protections.
In 2017, California enacted and implemented strong protections against surprise billing for patients in health facilities with AB 72. AB 1611 closes remaining gaps in state law and extends important consumer protections for those that get care in emergency rooms.
The bill is already prompting change. After high-profile stories and public pressure earlier this year, Zuckerberg San Francisco General Hospital (ZSFG) announced a proposal to end their egregious practice of keeping their ER out-of-network in order to charge insured patients higher rates. But ZSFG is not alone – many other hospitals also engage in this practice. AB 1611 would prevent balance billing and surprise emergency bills statewide.
Patients in an ambulance are in no position to choose what emergency room they end up at, and certainly should not get any extra or inflated charges if the hospital is out-of-network. AB 1611 is a key consumer protection that could help save Californians from crushing medical bills.
AB 1611 now moves to the State Senate for policy hearings in the coming weeks.
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