California's proposal to end surprise ER bills: 7 things to know

California lawmakers will introduce surprise emergency room billing legislation Feb. 25, after a recent story highlighted the issue at a San Francisco hospital, according to a Vox report.  

Seven things to know:

1. The bill is being introduced by state Assemblyman David Chiu and state Sen. Scott Wiener.

2. It would prohibit hospitals in the state from charging patients who receive emergency room care beyond their regular copay or deductible, according to the report. The ban would apply even if the hospital is not in the patient's insurance company's network.

3. The new legislation comes after a January Vox story revealed that Zuckerberg San Francisco General Hospital, the city's largest public hospital, is out of network with all private health plans, which can leave patients with massive bills.

The story particularly highlighted the hospital's practice of balance billing. This occurs when privately insured patients receive trauma or emergency services from an out-of-network provider and are billed for the balance after the insurance company pays its portion.

5. After the January Vox story, Zuckerberg hospital announced Feb. 1 that it would be halting balance billing for 90 days to finalize a plan to address billing issues in the long term.

6. San Francisco health officials are  considering a cap on out-of-pocket payments for privately insured patients receiving emergency services at the hospital.

However, Mr. Chiu said he believes there should be more efforts, such as the California proposed bill.

"This all came to my attention through your article," Mr. Chiu told Vox. "When your story broke, I started digging into how state law impacted the situation and saw that there were some clear holes in California policy that we needed to address."

7. California reportedly already has some protections against surprise medical bills, but the new legislation would address a specific situation where a hospital is out of network, and the patient is billed for the balance after the insurance company pays its portion.

In addition to the ban on hospitals pursuing charges beyond the patient's regular copay or deductible, the bill also would limit prices hospitals could charge for care to 150 percent of the Medicare price or the average geographic area contracted rate, whichever is more, Vox reported.

.Access the full report here.


More articles on healthcare finance: 

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Zuckerberg hospital considers cost cap for privately insured patients amid billing uproar

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