California bill to stop ‘surprise’ medical charges clears hurdle

The California Senate Appropriations Committee on Thursday voted to approve a bill that would shield patients from so-called “surprise medical bills” that are often incurred when people unknowingly receive care from out-of-network providers.

Currently, many health plan enrollees have no way of knowing whether specialists such as anesthesiologists or pathologists are in-network prior to surgical procedures, which can result in significantly higher costs than anticipated.

The bill would ensure that patients pay non-contracting providers the same as in-network providers. The legislation would also require that payments to non-contracting providers by health plans be 125 percent of the Medicare rate or the normal contracted rate — whichever is greater.

A similar measure nearly passed the state legislature last year but fell three votes shy after a last-minute lobbying blitz.

Health advocacy groups cheered the advancement of the bill, which is now headed to the full Senate floor for a vote.

“When patients follow the rules of their plan and go to an in-network hospital or other facility, they should not be hit with a surprise bill of hundreds or thousands of dollars from an out-of-network doctor they did not meet or ever choose,” said Anthony Wright, executive director for Health Access California, a state health consumer advocacy coalition that is also co-sponsoring the bill.

“These unexpected bills are not just unfair, they can mean fiscal calamity for many low-income families.”

The bill must be passed by the legislature and sent to the governor by August 31.