California residents who have to visit out-of-network medical providers will get much-needed economic protection under a new bill just passed by state legislators. The bipartisan bill, AB72, assures that patients who received care in in-network facilities would have to pay only in-network cost sharing, regardless of whether the provider who treated the patient is in-network or out-of-network. This would not apply to self-insured employer health plans, however, which are shielded from state regulations by the federal Employee Retirement Income Security Act. Insurers will have to pay noncontracting physicians the plan’s average contracted rate or 125% of the Medicare rate, whichever is greater. The bill also tightens requirements on health plans to offer adequate provider networks. Florida and New York have enacted similar laws; other states continue to weight their options.
New California Bill Protects Patients from ‘Surprise’ Medical Fees