Doctors, insurers in California at odds over bill on surprise medical bills


It looks like California lawmakers will soon decide the fate of a bill that would protect patients against surprise medical bills--a proposal that has divided doctors and insurers.

The California Senate on Monday voted 28-1 to pass the bill that would protect patients from costs when unknowingly treated by a doctor not covered by their insurance, according to STAT. The controversial bill could come up for a vote by the state assembly later this week and then would need approval by the governor to become law.

Under the bill, a patient would only have to pay the equivalent of in-network rates if treated by an out-of-network doctor, which can happen, for instance, if a patient is undergoing surgery and receives care from an anesthesiologist not covered by the patient’s insurance plan or has X-rays read by a radiologist not in the network, according to the STAT report.

Some doctors have vigorously opposed the proposed law because it will require them to either accept lower payments in cases when a patient gets a surprise bill or otherwise seek arbitration. Under the proposal, out-of-network doctors would receive 125 percent of the Medicare reimbursement rate, which many doctors already criticize as one of the lowest in the country. “We’re supposed to hire an attorney or go off to a dispute resolution process, spend hours getting ready, and then hours at the process?” Michael Couris, M.D., a San Diego ophthalmologist told STAT.

Doctors in some markets already feel the pressure to accept significant reimbursement cuts to remain in an insurer’s narrow network. On the other hand, insurers are concerned the legislation could tie their hands in negotiations with healthcare providers and ultimately result in higher costs for consumers, Nicole Evans, a spokeswoman for the California Association of Health Plans, told the publication.

New York and Florida have passed similar laws to protect consumers against surprise bills and legislation is pending in Pennsylvania, New Jersey, Georgia, Hawaii and Missouri, according to the report.