California Bill Would Limit Hospital Charges on Out-of-Network ED Patients

California Senate Bill 359 (pdf), which would limit the charges of a hospital's out-of-network emergency department plan, has passed both the Senate and Assembly and now awaits the signature of Gov. Jerry Brown.

At its core, SB 359 attempts to prevent hospitals from profiting from the more lucrative out-of-network ED admissions. By law, health insurers must pay for emergency care regardless of whether the insurer is in the hospital's network. Specifically, it would affect hospitals that have out-of-network ED utilization rates of 50 percent or more.

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The bill would limit a hospital's out-of-network payment to 60 percent of the payor's average in-network payments but would not be less than 150 percent of Medicare.

The Service Employees International Union-United Healthcare Workers West has supported SB 359 and has urged Gov. Brown to sign it into law.

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