Bill AB 72 would require physicians bill patients at in-network rates, or 125 percent of the Medicare rate, if a patient inadvertently receives care from an out-of-network physician, such as an assisting surgeon or anesthesiologist. The state senate has until Aug. 31 to approve the bill.
Physicians, insurers and lawmakers largely agree surprise medical bills should not fall on consumers’ shoulders. But accomplishing that requires finding a delicate economic balance in markets where physicians and payers typically battle over reimbursement rates.
Nicole Evans, spokesperson for the California Association of Health Plans, told STAT News the pending legislation could tie insurers hands when it comes to negotiations with healthcare providers. Hospitals’ in-network rates could rise as a way to balance costs. This would eventually be passed down onto consumers through higher insurance premiums, according to the article.
“We need to make sure the language in this bill does not inadvertently increase premiums. We want to make sure we can build our networks and get a good, fair price for consumers,” Ms. Evans told STAT News.
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