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.
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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