STATE | ASPS and CSPS Work to Amend CA Balance-Billing Legislation
State legislatures throughout the country are taking action in response to constituent complaints of surprise bills following visits to the emergency room and after receiving care from non-covered providers at covered facilities. New York passed legislation in 2015 to address surprise billing and out-of-network claims, soon followed by Connecticut and Florida. In 2016, the California State Legislature is currently engaging in a similar legislative effort.
On August 8, the California Senate Appropriations Committee considered A.B.72, which would amend existing laws on out-of-network services performed at in-network facilities by, in part, introducing a fee schedule to determine payments in these circumstances. Most concerning, this fee schedule sets the rate paid at the greater of the average of the payer contracted rate or 125% of Medicare, a structure that severely disadvantages providers. As an alternative, ASPS recommended that the state utilize an independent third party claims data base, such as FAIR Health, to establish fee schedules. ASPS has also requested that the sponsor consider including language that would allow for the automatic assignment of benefits by patients to their out-of-network providers.
While ASPS is opposed to aspects of the legislation, it does support provisions that permit patients to receive care from out-of-network providers as long as the patient consents to pay the provider's charge in addition to the patient's out-of-network benefit. ASPS believes this is a necessary provision in any out-of-network legislative proposal, as it preserves the patient's right to access physicians outside of their network when certain specialists are not available or when a non-contracted provider is better equipped to serve a patient's specific care needs.
Both ASPS and the California Society of Plastic Surgeons, respectively, have written to the California State Senate, telling legislators that they will oppose the bill unless it is amended to include a more equitable data set for determining payments under the fee schedule. The California State Senate is likely to vote on this bill within the next two weeks. If you are a California resident and would like to write a letter to your Senator urging him or her to amend this legislation, click here.