Five Things to Know About the Balance Billing Law

Last year, the California Legislature passed Assembly Bill 72, which forbids balance billing for out-of-network care at in-network hospitals or facilities. The law took effect July 1 of this year.

In a recent San Diego Union Tribune article, Betsy Imholz, special projects director for Consumers Union, a nonprofit policy and advocacy group affiliated with the product testing and rating publication Consumer Reports, stated that California has implemented some of the strictest rules in the country against balance billing. Some of the most common balance-billing situations involve anesthesiologists and imaging services delivered in settings that range from hospitals and labs to standalone imaging centers. Other possible situations include lab testing, EMS ambulance services, ambulatory surgical centers, and other in-hospital services.

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Here are five things to know about the rules:

1. Assembly Bill 72 forbids balance billing for out-of-network care at in-network facilities.

2. Older California statutes forbid balance billing in emergency situations.

3. Insurers are required to accept complaints for suspected surprise billings and have 30 days to solve the problem. If consumers are dissatisfied with the result, the state's Department of Managed Health Care will step in.

4. California's balance billing legislation doesn't include self-insured health plans regulated by the U.S. Department of Labor under the Employee Retirement Income Security Act, which covers an estimated 40 percent of those with commercial insurance in the state.

5. Only 15 states have some protections against balance billing to date, and only six have comprehensive protection.

More information can be found at the California Society of Anesthesiologists website and at the California Medical Association website (membership required).

Other Resources:
California Legislative Information
California Ambulatory Surgery Association (CASA)

 

The above item was authored by Ann Whitehead, RN, JD, Vice President, Risk Management and Patient Safety for CAP. Questions or comments related to this article should be directed to awhitehead@CAPphysicians.com.

This communication is not intended to create or constitute, nor does it create or constitute, an attorney client or any other legal relationship. No statement in this communication constitutes legal advice nor should any communication herein be construed, relied upon, or interpreted as legal advice. This communication is for general information purposes only regarding recent legal developments of interest, and is not a substitute for legal counsel on any subject matter.