New law to shield patients from surprise medical bills met with resistance by doctors
Written on behalf of Brian S. Kabateck | Kabateck LLP
November 4, 2016
Needing an important medical procedure is often traumatic enough. But what about when you receive a bill for hundreds, even thousands of dollars more than expected because one specialist, that you did not choose, was an out-of-network provider?
The expensive specialist is often familiar with the main provider or hospital, or may be the only one available that day—conveniences to doctors that are unknown and likely unwanted by customers seeking to avoid extra expenses.
Gov. Jerry Brown recently signed into law by Assembly Bill 72, authored by Assemblyman Rob Bonta (D-Alameda). This new law prevents expensive “surprise billing,” by out of network providers for emergency expenses.
Some doctors strongly campaigned against AB 72. The Association of American Physicians and Surgeons has even filed suit against it, naming the governor and the head of the state Department of Managed Health Care as defendants. They cite that limiting the reimbursement of out-of-network doctors could de-incentivize them from offering reduced cost medical care, which would disproportionately affect predominantly underinsured minority communities—a violation of constitutional equal protection clauses. They also claim that insurance companies will lower contract rates of even in-network doctors, driving down physician participation. This could cause an exodus from California of doctors to seek relief.
Assemblyman Bonta countered these complaints, stating that the law “expressly provides due process for physicians by allowing them to seek any legal remedy they see fit if they are dissatisfied with their compensation.”
The director of special projects for Consumers Union, Betsy Imholz, found the lawsuit to be without merit, and opined that the benefits of lowering health care costs for patients outweighed the loss of income for certain specialists. She cited a recent Kaiser Family Foundation survey that the consequences of surprise billing have been that 61% of those with problems find difficulty with paying other bills, and that 35% cannot pay for essentials such as food or housing. Patients can have their credit ruined with long-standing medical bills, making the road to obtaining credits cards or mortgages very difficult.
Ultimately, time will tell if the doctors’ fears will be realized. Though in the short term, patients might be spared catastrophic bills that could wipe out their financial futures, if doctors truly feel that they are getting a raw deal, they may leave en masse to states more favorable to their needs. And losing the right specialist for heart or brain surgery could have far more permanent effects than a temporarily low bank account.
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