California struck the most recent blow against surprise out-of-network medical bills. Surprise bills are different from the bills you get when you knowingly choose an out-of-network provider. Those are painful, but they aren’t a surprise. The classic example of a surprise bill is the one an out-of-network anesthesiologist sends after surgery by an in-network surgeon at an in-network hospital.
In September California Governor Brown signed Assembly Bill 72 requiring that policies issued on or after next July 1 provide that if an insured patient receives covered services at an in-network facility from an out-of-network provider, the patient needn’t pay more than the in-network provider rate. There is an exception when the patient has specifically consented to the higher rate; that bill wouldn’t be a surprise.
New York State protects patients from surprise bills not only when they are treated at an in-network facility but also when referred by an in-network physician to an out-of-network physician or service provider, including laboratory services. The law provides that a patient need pay only the in-network rate, provided he forwards the surprise bill to his insurer, along with an assignment form allowing the out-of-network provider to seek payment from that insurer.
The HHS Budget in Brief for fiscal year 2017 recites yet another approach to the problem: “Hospitals would have to take reasonable steps to match individual patients with providers that are … in-network…. Furthermore, all physicians who regularly provide services in hospitals would be required to accept an appropriate in-network rate….”
Still another approach is reflected in the insurance policy requirements CMS has proposed for 2018: if a patient is required to pay an out-of-network bill for services at an in-network hospital, the excess amount above the in-network rate would count toward the patient’s annual deductible. 2017 Payment Notice at §156.230(e).
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