For Immediate Release: Tuesday, January 5, 2022
CONTACT: Rachel Linn Gish, director of communications, rlinngish@health-access.org, (916) 532-2128 (cell)
NEW NATIONAL PATIENT PROTECTIONS AGAINST SURPRISE MEDICAL BILLS NOW BENEFITTING MILLIONS MORE IN CA AND ACCROSS THE COUNTRY
Updated Health Access Report Released Today Details California’s Experience, Undercuts Opposition Arguments
- Despite opposition from some health providers, new rules from US HHS Secretary Becerra are now in effect to prevent patients from getting unexpected out-of-network medical bills, often costing consumers thousands of dollars, if not much more.
- While California has had in place its own landmark law against surprise medical bills from out-of-network physicians, AB 72, since 2017, the federal law now extends these patient protections to over six million Californians in federally-regulated plans, and millions more across the country, as well as filling in gaps in state law on emergency rooms and air ambulances. See our fact sheet on the California impact.
- California’s experience undercuts the arguments and scare tactics by law’s health industry opponents. A new Health Access report released today (updated from the original 2019 report) describes the positive impacts of that state law, which actually goes further than the federal deal in preventing inflated health prices. More recent studies show patients protected, providers paid, and networks increased.
- While consumers should now be taken out of the middle of these billing disputes, they should remain vigilant about what their plan covers, if a provider is out-of-network, cost sharing, and more.
SACRAMENTO, CA – On the week that new federal rules go into effect to prevent patients from getting surprise medical bills, consumer advocacy group Health Access California releases an updated report on the California experience of a similar state law. The report shows the laws success in protecting patients from unexpected out-of-network bills as well as inflated premiums from provider overcharging with no indication of negative impacts on network size or patient access to care.
“Finally, we have federal rules in place providing comprehensive consumer protections to prevent surprise medical bills, which can often be in the hundreds or thousands of dollars, if not much more. This solution to stop surprise medical bills protects patients, both from getting stuck with a life-altering bill because their medical provider was unexpectedly out-of-network, and from inflated premiums as well,” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “While the federal rules fill in the gaps in our state protections, California’s experience is useful to show the success of these protections, ensuring patients are protected and providers paid, with no evidence of a negative impact on access to care or network size.”
The updated report demonstrates how the state law, AB 72, which served as a model for the national law, has been successful in protecting patients from surprise bills which occur when patients go to an in-network hospital or facility but then get a bill from an out-of-network doctor. These bills come as a surprise to the consumer who did the right thing by going to an in-network facility or who sought emergency treatment that can often be hundreds or thousands of dollars or more.
California’s experience shows that providers are accepting the payments based on a benchmark similar to the “qualifying payment amount” in the federal regulations, with very few appeals in the four years since the state put in place its protections. This and even more recent reports have shown no negative impact on patient access to care, with provider networks actually expanding.
CALIFORNIA’S EXPERIENCE SHOWS FEDERAL FIX WILL WORK: “California’s experience shows that this federal fix will work, preventing patients from getting billed by these out-of-network doctors, ERs, and air ambulances, while also preventing providers’ inflated charges from raising our premiums. California’s reality undercuts the scare tactics of some health providers that oppose the law and these important patient protection rules. In California, millions of patients have been protected, yet providers were paid fairly and timely, with few provider complaints or appeals, and networks actually increased, improving patient access to care,” said Wright.
MILLIONS OF CALIFORNIANS TO BENEFIT: “These new federal rules thankfully keep California’s strong state solutions regarding physician surprise bills in place, while filling in key gaps, especially around emergency room bills and air ambulances, and for the over six million Californians in federally-regulated health plans exempt from state patient protections, and millions more across the country,” said Yasmin Peled, senior policy advocate with Health Access California, and the author of this fact sheet on the California impacts of this federal law. In California alone there are six million people who do not fall under California’s AB 72 protections because they are in federally regulated health care plans. Another million Californians are in plans regulated at the state Department of Insurance (CDI) and while they have protections against physician balance billing, they did not have the same protections against emergency room bills.
DIRECT CONSUMER ADVICE: “With these new rules in place, consumers should be taken out of the middle of these billing disputes between health plans and providers. Frankly, they shouldn’t have gotten these surprise bills in the first place, and hopefully they won’t now without any action by the patient,” said Wright. “That said, patients should still be vigilant about what their plan covers and doesn’t, what is the cost-sharing in their plan, and whether their providers are out-of-network or not.”
“Patients can sign a consent form to knowingly go out-of-network for a certain provider and be charged accordingly, but that should be done well before the service—no patient should be coerced to have to accept such a deal,” said Wright. “Finally, patients need follow-up legislative action, to address the biggest gap in these federal and state protections, which are surprise medical bills by ground ambulances.”
In supporting the new federal regulations, Health Access submitted comments with numerous citations of studies showing California’s experience, and signed another letter with leading California consumer, labor, business, and insurer organizations in support.
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