While a law addressing balance billing has helped California patients avoid surprise out-of-network bills, physicians argue the regulation has put them at an unfair disadvantage in insurance negotiations, according to California Healthline.
The 2017 law aimed to protect patients who use in-network hospitals from getting balance billed for services provided by an out-of-network provider. Now when this situation occurs, patients only cover a copay, while physicians are paid by an insurer based on whichever is higher: the average contracted rate for the service or 125 percent of Medicare.
However, when it comes to negotiating contracts with payers, physicians say they now have little room to press for different rates. A recent survey from the California Medical Association found almost 90 percent of the 855 physician practices that responded said the law has let insurers narrow physician networks and limit patient access to in-network physicians.
Physicians feel the payment standard has made insurers less likely to negotiate for new prices, pushing groups to combine to secure greater leverage, according to the report. Physicians warn costs will go up as a result, according to California Healthline.
To read the full report, click here.