Consumers know they can save money and limit their out-of-pocket costs by going to an in-network provider. Too often, however, consumers who do the right thing by going to an in-network hospital or facility end up getting a surprise bill by a doctor who turns out not to be in-network. According to a recent survey by Consumers Union, nearly one in four Californians have received a surprise medical bill after a hospital visit or surgery with the price they are asked to pay an out‐of‐network rate when they thought the provider was in‐network.
These surprise or “gotcha” bills can add up to hundreds, even thousands of dollars, driving some patients into medical debt. The consumer is stuck paying the bill for care they needed, and had every reason to think, was in-network. Or worse yet, the consumer does not pay because they don’t think they owe the money and then the consumer gets taken to collections and their credit is ruined.
Sometimes it is an anesthesiologist who administers anesthesia, a radiologist who reads an X-ray, or a pathologist who analyzes test results. This practice, also known as “balance billing,” is all too common in California. What is worse, because the consumer inadvertently got care out of network, not a dime counts toward the Affordable Care Act’s annual out of pocket maximum of $6,600.
AB 533 (Bonta), sponsored by Health Access California, would protect patients who visit an in-network hospital or facility but then get a “surprise bill” from an out-of-network doctor, one they probably never met or did not choose. While Californians in managed care plans cannot be “balance billed” for care provided in the emergency room, AB 533 prohibits surprise billing for care provided in all facilities, impacting 22 million Californians.
Under AB 533, if consumers do the right thing by visiting in-network hospitals or facilities, they will pay in-network charges and co-pays for all the providers they encounter in their visit. The total amount of cost sharing will also count toward their out of pocket maximum.
AB 533 has received bipartisan support and will be heard in the Senate Appropriations Committee later this month. It is opposed by the California Medical Association and other groups representing doctors.