Member-supported news for Southern California
Play Live Radio
Next Up:
Available On Air Stations
Support for KPCC comes from:

CA lawmaker to try again to block 'surprise' medical bills

Beginning in January, California will limit its Medi-Cal recovery claims to costs associated with nursing home care, which is required by federal law.
Pictures of Money via Flickr Creative Commons
Beginning in January, California will limit its Medi-Cal recovery claims to costs associated with nursing home care, which is required by federal law.

A state assemblyman is trying again to win passage of a bill that would eliminate unexpectedly high medical bills, the kind that hit patients who have received care at a medical facility outside of their insurance network without knowing about it.

This typically happens when a covered facility uses out-of-network specialists, such as radiologists or anesthesiologists. Providers who work outside of a consumer's insurance plan typically charge far higher rates than in-network providers.

Assemblyman Rob Bonta (D-Oakland) will try again to secure approval of AB 533, which fell three votes shy of passage in the Assembly last fall. The measure would limit the amount a patient can be charged by an out-of-network provider to no more than he would have paid if that provider had been in-network.

Consumers Union and Health Access California are backing the bill; they believe it would close a costly loophole in the health insurance system.

"Due to legislative inaction, thousands of Californians continue to get these surprise bills,"  says Anthony Wright, executive director of Health Access California, a co-sponsor of the legislation. "We believe with increased pressure... that we will be able to get this passed this year."  

The California Labor Federation, which represents 2.1 million workers statewide, is also supporting the bill.

The California Medical Association says it too wants to end the practice of surprise medical billing. But it opposes the Bonta legislation, calling it an "unbalanced solution" that would pay doctors too little and give insurers and health plans too much. 

"We're not in agreement with a solution that creates a financial windfall for health plans and health insurers at the expense of protecting patient access to care," says Janus Norman, the Medical Association's senior vice president of governmental affairs. 

Norman says his organization wants a plan — similar to one passed in New York — that would protect patients from surprise bills while also fairly compensating doctors when they step in to provide services for insurers with small provider networks.  

The Bonta plan, he says, would reduce payments to those physicians by two-thirds. 

"It is a... convoluted attempt at addressing a problem and failing to recognize the thoughtful work other states have done," Norman says. 

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

The survey found that nearly two-thirds of Californians assume that doctors who work at an in-network hospital are also in-network.

This story has been corrected to reflect that the 2015 survey was by Consumers Union, and to correct the survey's finding about how many Californians were charged an out-of-network rate.