For Immediate Release: Wednesday February 10, 2021
Rachel Linn Gish, director of communications, Health Access California, email@example.com, 916-532-2128 (cell)
CA BILL STRENGTHENS SURPRISE MEDICAL BILL PROTECTIONS AFTER WIN AT THE FEDERAL LEVEL
- Congress passed the No Surprises Act at the end of the last year benefiting millions of Californians who will now have protections against receiving surprise out-of-network bills when receiving in-network care, no matter who their insurer is.
- The new federal law keeps in place California’s four year-old landmark law against surprise medical bills from out-of-network physicians, AB 72, but there are areas with the new federal law has even stronger protections than state law.
- A new CA bill, AB 510 (Wood) conforms state law with federal law, particularly regarding a patients’ ability to consent to go out-of-network.
SACRAMENTO, CA – A new California bill introduced today, AB 510 by Assemblymember Wood, will strengthen California’s already historic protections against surprise medical bills. While California’s AB 72 (2016) already protected most Californians from receiving costly medical bills for out-of-network care unknowingly received at an in-network facility, Congress recently passed the No Surprises Act which fills in most of the gaps which remained. The No Surprises Act, which will go into effect January 1, 2022, will cover the over 6 million Californians with coverage regulated at the federal level who were not protected under AB 72. While the state law is stronger in many areas, the new federal law includes some reforms that are even more consumer friendly than state law. AB 510 will conform state law with federal law, particularly regarding a patients’ ability to consent to go out-of-network.
“Closing the loopholes which still allowed consumers to receive huge out-of-network surprise bills has only grown more urgent during this pandemic when many are finding themselves in the hospital or seeking emergency care. Aligning state and federal law will codify powerful consumer protections and keep Californians from falling into traps that might lead to a costly bill,” said Yasmin Peled, policy and legislative advocate for Health Access California, a sponsor of AB 510.
Under the federal No Surprises Act, a patient can consent 72 hours in advance to receive care from certain types of providers who are out-of-network. However, this provision does not apply to emergency care or certain providers, including: anesthesiologists, radiologists, pathologists, neonatologists or if there is no in-network doctor at in-network hospital. Current California law allows consent only 24 hours in advance if given in writing and does not include any exemptions. AB 510 will adopt these stronger provisions that will reduce the number of potential out-of-network providers and give patients more time to consider their options when deciding whether or not to consent to out-of-network care.
California will retain one of the most important provisions of AB 72, its payment standard for out-of-network physicians, which is better for consumers than the payment structure established in the federal No Surprises Act. In California, the payment between physicians and insurers remains the greater of 125 percent of Medicare, or the “average contracted rate” for that service for that health plan in that region. Providers or insurers can appeal through an Independent Dispute Resolution Process. This payment standard prevents inflated rates that may end up occurring in the structure established under the new federal law while ensuring that providers are paid fairly.
“The federal act does not include a benchmark payment standard like California’s but instead relies on voluntary negotiations between insurers and providers, backed up by arbitration if negotiations fail,” said Assemblymember Wood, author of AB 510. “We have absolutely no interest in changing California’s current payment structure because it provides the most effective patient protections and also serves us well in controlling health care costs,” said Wood. “We put California’s benchmark payment structure into statute to protect patients, not to make payments more lucrative for providers.”