California Out of Network Legislation Passes Senate Committee
In California, AB 533 has passed the Senate Committee. The purpose of this bill is to prevent out of network (OON) providers to balance bill patients, when they are seen at an in-network facility. According to the legislation, OON physicians would be prohibited from charging or collecting from the patient any more than their co-insurance or deductible under their policy. Attacking reimbursement further, this bill would require the carrier to pay the physician at the plan’s “average contracted rate,” which would be confidential and not subject to disclosure or review. An appeal process would then have to be initiated, if the physician group is unhappy with rates paid for services rendered. If passed and enacted, this legislation would give carriers way too much power to set rates for services without negotiations. The California Society of Pathologists and the California Medical Association have expressed their opposition, along with other medical specialty societies. APS will continue to keep you updated as this legislation moves through the process.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.