Good news for CA healthcare consumers - AB 72

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boglesmind
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Good news for CA healthcare consumers - AB 72

Post by boglesmind » Thu Sep 01, 2016 10:06 am

From San Jose Mercury News
Currently, patients who schedule medical procedures at in-network facilities may still unwittingly receive care from out-of-network physicians who can bill them directly, bypassing insurance companies completely. Health care access advocates cheered the passage of Bonta's AB 72 as a huge victory.

"This bill is the most significant step any state has taken to protect patients who end up in the crossfire of billing disputes between insurers and providers," said Anthony Wright, executive director of Health Access California, a nonprofit health consumer advocacy coalition.
I've seen friends go to in-network hospitals and getting unexpected huge bills from out-of-network practitioners who treated them there, esp. during an operation when one has no prior indication of who the attending anesthesiologists or radiologists are and whether they are in-network or not. AB 72 attempts to fix this by 1) allowing those providers in-network charges only and 2) making any exceptions pretty tight. See Section 1371.9 in https://leginfo.legislature.ca.gov/face ... 520160AB72

The exceptions to the new rule are pretty tight mostly. Emergency services are excluded from the above requirement unfortunately.

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furikake
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Re: Good news for CA healthcare consumers - AB 72

Post by furikake » Thu Sep 01, 2016 11:46 am

This is great! Hope all states will adopt the same rules.

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celia
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Re: Good news for CA healthcare consumers - AB 72

Post by celia » Thu Sep 01, 2016 12:21 pm

I have problems with the link. But it sounds like another set of complicated rules and exceptions (if I understand you).

And what's the point of excluding Emergency Services? That's when you're least able to have the ability to go elsewhere, to have many choices, or the ability to make thoughtful choices.

Forcing doctors to accept what insurance pays when they never agreed to it will have unattended consequences, such as "not being available" when they are needed.
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Spirit Rider
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Re: Good news for CA healthcare consumers - AB 72

Post by Spirit Rider » Thu Sep 01, 2016 12:34 pm

Even though, I am a pretty strong libertarian (note: the small l, not those Libertarians). I would like to see this as a national law/regulation.

Around here you will find NO anesthesiologists who are in-network. They act more like a cartel than medical professionals.

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celia
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Re: Good news for CA healthcare consumers - AB 72

Post by celia » Thu Sep 01, 2016 1:24 pm

I have never been in a health plan that had anesthesiologists, ER doctors, or ambulance service as part of the in-network plan. And those are the more common services needed in an emergency.
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boglesmind
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Re: Good news for CA healthcare consumers - AB 72

Post by boglesmind » Thu Sep 01, 2016 1:53 pm

celia wrote:I have problems with the link. But it sounds like another set of complicated rules and exceptions (if I understand you).

And what's the point of excluding Emergency Services? That's when you're least able to have the ability to go elsewhere, to have many choices, or the ability to make thoughtful choices.

Forcing doctors to accept what insurance pays when they never agreed to it will have unattended consequences, such as "not being available" when they are needed.
1. I went through the rules and they don't appear to be complicated. When one selects a hospital and schedules a procedure after checking that the hospital is in-network, one does NOT expect unpleasant surprises such as out of network charges or worse, bills from medical practitioners (at the hospital) who don't even accept any insurance. This bill addresses that.

2. No one forces doctors to practice at hospitals that accept certain insurance plans. It just levels the playing field for patients so that they are informed *specifically* *beforehand* that such and such practitioners are out of network or not accepting insurance would perform services for the patient and this is the estimated cost for their services and get the patient's consent in writing. This is for regularly scheduled procedures. Emergency services are an exception probably because there isn't time to get such informed consent and "emergencies" need to be handled first.

3. I am with Spirit Rider.

4.
celia wrote:I have never been in a health plan that had anesthesiologists, ER doctors, or ambulance service as part of the in-network plan. And those are the more common services needed in an emergency.
Although I never used any of the above services, I once used a hospital for a chest X-Ray and the $900 bill with $200 co-pay made me switch to a local, well-regarded HMO. The HMO covers emergency treatment at any other hospital if the 911 or ambulance service takes you there.

We have a long way to go to fix healthcare in this country and these are baby steps.

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magellan
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Re: Good news for CA healthcare consumers - AB 72

Post by magellan » Thu Sep 01, 2016 7:34 pm

boglesmind wrote:Emergency services are excluded from the above requirement unfortunately.
I think the ACA may have already mandated something similar to this for emergency services, at least on the insurance side of things.

As I understand it, insurers aren't allowed to charge you more than the in-network deductibles/co-pays for emergency care, even from an out of network facility or provider.

Although there is still the risk of getting balance billed from the provider if the insurer pays them too little.

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magellan
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Re: Good news for CA healthcare consumers - AB 72

Post by magellan » Thu Sep 01, 2016 7:51 pm

As an aside, I was recently at an in network hospital for a test and before I would let them do it, I asked if they could confirm that the radiologist would be in network.

After giving me the info, the receptionist said that SHE herself had just been burned by this. Apparently, the insurance plan the hospital offers its employees doesn't include the radiology practice that the hospital uses in its network. So any time a hospital employee goes to their own hospital/employer for a test or procedure that involves a radiologist, they get hit with a surprise out of network charge.

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Re: Good news for CA healthcare consumers - AB 72

Post by LadyGeek » Thu Sep 01, 2016 8:27 pm

This thread has run its course and is locked (proposed legislation). See: Unacceptable Topics
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The reason should be clear, but in case it's not...
Very rarely do legislative proposals make it into enacted law and never do they emerge from the legislative process as originally proposed. But some people do get worked up over the proposals - leading to extra work for the moderators - and in the worst case even make negative financial decisions based on them.
Take another look at AB-72 Health care coverage: out-of-network coverage.

Go to the Compare Versions tab. Then, compare how many times, along with what changed, from the bill's introduction to what you see now.

The bill's status can be found in the Status tab.

"08/31/16 Senate amendments concurred in. To Engrossing and Enrolling."

Terminology and process is here: A Guide for Accessing California Legislative Information on the Internet (The bill has yet to be signed by the governor.)
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Re: Good news for CA healthcare consumers - AB 72

Post by LadyGeek » Tue Sep 27, 2016 7:51 pm

This thread is now in the Personal Finance (Not Investing) forum (insurance). After receiving a PM, this thread is now unlocked.

The bill has been signed into law, the discussion can continue. See: AB-72 Health care coverage: out-of-network coverage.
[ Approved by Governor September 23, 2016. Filed with Secretary of State September 23, 2016. ]
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Re: Good news for CA healthcare consumers - AB 72

Post by goodenyou » Tue Sep 27, 2016 11:25 pm

Many people do not understand the relationship between hospitals and doctors. Traditionally, doctors were on-call and available as a courtesy to the hospital and community. Doctors were fairly compensated in the past for this arrangement. The remnants of this model still exist. However, with the changes in health care economics, doctors are less likely to volunteer to be available to hospitals and the community. The hospitals have no choice but to employ physicians from every specialty or remain "uncovered " for that service. This forces transfers of patients to hospitals that have that care available and doctors willing to accept the fee schedule. Narrowed networks used to "control costs" will only exacerbate the problem of unavailability. There are many communities that have no specialty surgeons on call. The communities are unaware and patients only realize it when they show up in an emergency. If the hospitals want to provide the care, they can arrainge to pay the difference for out of network costs. It is often easier to transfer the patient to a facility that had a doctor available and inconvenience the patient than it is to provide the care.
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Re: Good news for CA healthcare consumers - AB 72

Post by Mudpuppy » Thu Sep 29, 2016 11:27 pm

Along with this bill, there are several other health care related bills that Governor Brown signed: http://www.sfgate.com/business/article/ ... 242927.php

When I had surgery right after graduating from college (undergraduate degree), it included a "surprise" bill from the anesthesiologist even though everyone else involved in the surgery was in-network. That was a rude awakening to "adult life".

boglesmind
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Re: Good news for CA healthcare consumers - AB 72

Post by boglesmind » Fri Oct 12, 2018 3:06 pm

The bill was challenged by the AAPS (American Association of Physicians and Surgeons) and the challenge was dismissed by the United States District Court, E.D. California with leave to amend.
AAPS has filed a first amended complaint and no decision yet on the amended complaint. See related thread Website article on lawsuits over hospital balance / surprise billing

The article by Manatt Phelps & Phillips LLP has a nice summary of the issues involved and the stand taken by California Medical Association (CMA) which has remained neutral on the case.
The California Medical Association (CMA) took a more balanced approach. ... Ultimately, the CMA took a neutral position on the Act, recognizing the need to protect patients from exorbitant surprise bills and concluding there were adequate protections in the Act for Physicians.
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