California Assembly Passes Measure To Ensure Consumers Don’t Face Costly Surprise Medical Bills

When you’re recovering from surgery, the last thing you want is to be blindsided by an unexpected bill for hundreds, if not thousands, of dollars because the hospital hired an out-of-network anesthesiologist or other specialist without telling you. Unfortunately, this type of surprise medical bill has become an unwelcome reality for nearly 30% of privately insured Americans. California lawmakers have just cleared a major hurdle in their goal of enacting a law that would protect consumers from unforeseen and often unavoidable medical charges. 

The California Assembly voted 61-1 yesterday to pass a measure aimed at safeguarding patients from unfair surprise medical bills when they go to an in-network hospital or facility and get charged extra from out-of-network doctors.

The legislation is part of a package of bills intended to prevent unfair out-of-pocket costs for consumers. The bill moves on to the California Senate.

Under the pending bill [PDF], if a patient obtains care at an in-network facility but from an out-of-network provider, they would only be required to pay the non-participating provider what would have been charged by a participating provider.

Essentially, that means if you go to your regular doctor’s office – which is covered by your insurance – and you see a doctor who isn’t covered by your insurance, you would only be on the hook for the amount you would typically pay if the doctor you saw was considered in-network.

Additionally, any cost that the patient pays for services by the non-participating provider will count toward their limit for annual out-of-pocket costs.

The measure applies to health care service plan contracts and insurance policies issues, amended or renewed on or after January 1, 2016.

“The Assembly took a bold step to stop surprise bills from imperiling the family finances of California patients,” Anthony Wright, executive director for consumer advocacy group Health Access California, said in a statement [PDF]. “Californians who do the right thing under their health plan and go to an in-network hospital should not face hundreds or thousands of dollars in bills from out-of-network doctors.”

“Once patients go to an in-network hospital, they shouldn’t be penalized for the radiologist, anesthesiologist, or other doctor that serve them that they never chose and in some cases never even met,” he continued. “[This legislation] will protect patients from unexpected and unfair medical bills.”

Advocates for Consumers Union, whose recent survey [PDF] found that one-in-four privately insured Californians face surprise medical bills, were quick to applaud the passage of the bill.

“Health insurance coverage should provide consumers protection against overwhelming medical bills and debt,” Julia Silas, senior attorney for CU, said in a statement. “AB 533 ensures that consumers who seek care at an in-network facility never end up paying more than the in-network co-pays, co-insurance, or deductible – even if the contracting doctors providing that care are out-of-network.”

Wright says that the still-pending legislation will be a positive step in helping provide economic security to Californians.

“The point of paying premiums for coverage is to protect against these surprise shocks to a family’s finances,” he says.