California legislature debates surprise medical bills

 Some doctors complain the proposed legislation would empower insurers to keep narrower networks and limit access to crucial health services.

In California, a fierce battle over surprise medical bills pits docs against insurers

For the second time in as many years, California legislators are debating a bill that would protect patients from paying surprise medical bills when they inadvertently get treatment from doctors who are not covered by their insurance.

Under the bill, AB 72, consumers would only pay the equivalent of in-network rates if, for example, during surgery covered by insurance, they are treated by an out-of-network anesthesiologist, or have X-rays read by an out-of-network radiologist. AB 72 is in the California Senate and must be approved before going to the state assembly and governor. The state legislature has until Aug. 31 to act, or the bill effectively dies in committee.

The legislation was sponsored by state Assemblyman Rob Bonta (D-Alameda), who sponsored a similar bill last year that languished over the finer points of what the lower, in-network-style payment would be.

Surprise medical bills occur in a small percentage of overall health care transactions, but they often result in thousands of dollars in unanticipated charges that are difficult for many people to afford. Patients get hit with these extra charges because, in the course of getting treatment, one or more ancillary providers aren’t on their insurance plan, even if the main provider, like a surgeon, is. That ancillary provider maybe someone who routinely works with a particular surgeon or hospital, or just happens to be the only one available that day, said Bonta, so even if patients do all their homework to make sure they are covered, it isn’t enough.

In California, this fight is on full display and the proposal is generating harsh criticism from some doctors because they have to take that lower rate or go to arbitration.  

“We’re supposed to hire an attorney or go off to a dispute resolution process, spend hours getting ready, and then hours at the process?” said Dr. Michael Couris, a San Diego ophthalmologist. “You’re telling me this is a tenable position? This is laughable.”

Some independent physicians argue the current proposal would only empower insurers to keep narrower networks, ignore independent physicians and small practices, and limit access to crucial health services.

Emergency Room surprise bills are common as well.

Mystery Solved: Private-Equity-Backed Firms Are Behind Ad Blitz on ‘Surprise Billing’

Two doctor-staffing companies are pushing back against legislation that could hit their bottom lines.

The emergency department doctor you see in the emergency room does not work for the hospital. He (She) is employed by an outside contract group who negotiated a contract with the hospital for care. This theoretically avoids the issue of hospitals employing physicians directly.  It eliminates the cost of benefits, vacation pay and deductions for taxes and health insurance.  Early this summer, Congress appeared on its way to eradicating the large medical bills that have shocked many patients after emergency care. The legislation to end out-of-network charges was popular and had support from both sides of the aisle. Legislation is also proposed in California and other states regarding surprise emergency medical bills.  The bills were well on their way to becoming law when a curious thing happened.  Private-Equity-Backed Firms launched an ad Blitz on ‘Surprise Billing’. Then, in late July, a mysterious group called Doctor-Patient Unity showed up. It poured vast sums of money (Dark Money) now more than $28 million — into ads opposing the legislation, without disclosing its staff or its funders.Trying to guess who was behind the ads became something of a parlor game in some Beltway circles. Whether this was by design or happenstance is moot, the end result will be the same.Now, the mystery is solved. The two largest financial backers of Doctor-Patient Unity are TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country, according to Greg Blair, a spokesman for the group.“Doctor-Patient Unity represents tens of thousands of doctors across the country who understand the importance of preserving access to lifesaving medical care and support a solution to surprise medical billing that protects patients,” said Mr. Blair, who issued the statement weeks after the group was first contacted about the campaign. “We oppose insurance-industry-backed proposals for government rate-setting that will lead to doctor shortages, hospital closures and loss of access to medical care, particularly in rural and underserved communities.” The two health staffing companies have both previously been accused of shifting the cost of uncompensated care in billing disputes to patients. Both say that's no longer the case and that they support a federal solution to surprise billings. But they don't like the congressional panels' approach, which they call government "rate-setting."Ending surprise bills, a big concern for voters of all stripes, was viewed as one of the only health issues in Congress with bipartisan appeal and the backing of the Trump administration. Everyone agreed that a patient who followed the rules and went to an in-network hospital shouldn't get slammed with enormous bills because he or she ended up with an out-of-network provider, such as an emergency physician or anesthesiologist. But insurers, employers, doctors and hospitals from the beginning have vigorously fought over how to solve the problem and who should pay.Two sources affiliated with Doctor-Patient Unity confirmed that Envision Healthcare and TeamHealth are funding a portion of the $28.6 million campaign that runs from July 30 to Sept. 17 in states including Alabama, California, Colorado, and New Hampshire, according to Advertising Analytics. The sources wouldn't say who else is involved but confirmed the two companies are funders.These two entities provide physicians through an obscure system which purchased multiple physician groups, not just in emergency medicine, but also many other hospital-affiliated physicians, HOSPITALISTS | CRITICAL CARE | RADIOLOGY | ANESTHESIA | WOMEN/CHILDREN | SURGICAL |andn OFFICE MEDICINE. It is a commonly accepted practice and affords ease of recruitment for hospital and physician groups.Greg Blair, a spokesperson for Doctor Patient Unity, also confirmed the two companies are funders, and in a statement said the pair represent tens of thousands of doctors who support an alternate approach to ending surprise medical bills that's been enacted in New York and Texas. Those states both use independent mediators to settle payment disputes — an approach known as arbitration — not a government-set pay scale.“We oppose insurance industry-backed proposals for government rate setting that will lead to doctor shortages, hospital closures and loss of access to medical care, particularly in rural and underserved communities,” Blair said in the statement.Envision and TeamHealth both confirmed they back Doctor Patient Unity and echoed similar sentiments.TeamHealth Executive Vice President Dan Collard said the group wants to submit billing disputes between health providers and insurers to arbitration instead of using government-set benchmark rates."We will continue to fight an insurance industry proposal to use government rate setting as a vehicle to increase their profits at the expense of potential hospital closures and doctor shortages in underserved communities," Collard said.

California legislature debates surprise medical bills: