SACRAMENTO – Over the past two years, 1.76 million Californians who already had healthcare benefits received surprise medical bills following hospital visits, according to a recent APCO Insight Survey. The practice known as balance billing results in individual medical bills ranging from $100 and under to upwards of $20,000 or more, and come even though a hospital contracts with a patient's health insurance plan.
Even worse, many of those who fall victim to this practice are enrolled in the state´s Healthy Families program, which provides healthcare coverage for uninsured children of low-income families, or are enrolled in the Access for Infants and Mothers (AIM) program designed for pregnant women.
On Tuesday, the Assembly Health Committee approved legislation authored by Senator Leland Yee (D-San Francisco/San Mateo) to end this practice against those enrolled in AIM and Healthy Families. The practice of balance billing is already prohibited for Medicare and Medi-Cal enrollees under existing federal and state laws.
Earlier this session, Yee introduced legislation to ban balance billing completely, but the bill stalled in the Senate Judiciary Committee.
"It is simply unfair for any patient to receive an excessive and surprise medical bill," said Yee. "It is unconscionable that low-income families are exposed to aggressive tactics, threats to their credit, and improper and coercive billing practices designed to intimidate them into making excessive payments they are not obligated to pay."
Specifically, balance billing happens when a provider sends a bill for an amount that is more than the contracted rate with the patient´s plan or when a non-contracted provider who works in a hospital, such as an anesthesiologist, radiologist, pathologist, or emergency room physician, sends a bill for any balance a health plan does not pay.
Due to the practice of balance billing, coverage alone does not necessarily mean that families are left without significant healthcare costs. Non-contracted doctors often over-charge patients relative to the rates that contracted providers accept. In fact, a recent survey showed non-contracting doctors over-charging Healthy Families recipients between 206 and 1769 percent. The most egregious examples were for an initial hospital inpatient consultation which Medi-Cal reimburses at $53.92, but the Healthy Families participants were charged on average $966.20 by non-contracted physicians.
A review of complaints made to the California Managed Risk Medical Insurance Board shows that four percent of such complaints received by the board were about balance billing. However, the number is likely significantly higher as individuals may also be reporting complaints to their health plans, Department of Managed Health Care, or may simply pay some or all of the charges without filing a grievance with any entity.
"Families enrolled in these two programs are in low- to moderate-income working families already struggling to make ends meet," said Elizabeth Landsberg, Legislative Advocate for the Western Center on Law and Poverty. "They should never be charged more than their co-pay just because, through no fault of their own, they ended up with an out-of-network radiologist or anesthesiologist."
Senator Yee´s SB 697 will explicitly prohibit a health care provider who is furnished documentation of a person´s enrollment in Healthy Families or AIM to seek reimbursement or attempt to obtain payment for any services provided to that person other than from the participating health plan covering that individual.
SB 697 will next be considered by the full Assembly.
Even worse, many of those who fall victim to this practice are enrolled in the state´s Healthy Families program, which provides healthcare coverage for uninsured children of low-income families, or are enrolled in the Access for Infants and Mothers (AIM) program designed for pregnant women.
On Tuesday, the Assembly Health Committee approved legislation authored by Senator Leland Yee (D-San Francisco/San Mateo) to end this practice against those enrolled in AIM and Healthy Families. The practice of balance billing is already prohibited for Medicare and Medi-Cal enrollees under existing federal and state laws.
Earlier this session, Yee introduced legislation to ban balance billing completely, but the bill stalled in the Senate Judiciary Committee.
"It is simply unfair for any patient to receive an excessive and surprise medical bill," said Yee. "It is unconscionable that low-income families are exposed to aggressive tactics, threats to their credit, and improper and coercive billing practices designed to intimidate them into making excessive payments they are not obligated to pay."
Specifically, balance billing happens when a provider sends a bill for an amount that is more than the contracted rate with the patient´s plan or when a non-contracted provider who works in a hospital, such as an anesthesiologist, radiologist, pathologist, or emergency room physician, sends a bill for any balance a health plan does not pay.
Due to the practice of balance billing, coverage alone does not necessarily mean that families are left without significant healthcare costs. Non-contracted doctors often over-charge patients relative to the rates that contracted providers accept. In fact, a recent survey showed non-contracting doctors over-charging Healthy Families recipients between 206 and 1769 percent. The most egregious examples were for an initial hospital inpatient consultation which Medi-Cal reimburses at $53.92, but the Healthy Families participants were charged on average $966.20 by non-contracted physicians.
A review of complaints made to the California Managed Risk Medical Insurance Board shows that four percent of such complaints received by the board were about balance billing. However, the number is likely significantly higher as individuals may also be reporting complaints to their health plans, Department of Managed Health Care, or may simply pay some or all of the charges without filing a grievance with any entity.
"Families enrolled in these two programs are in low- to moderate-income working families already struggling to make ends meet," said Elizabeth Landsberg, Legislative Advocate for the Western Center on Law and Poverty. "They should never be charged more than their co-pay just because, through no fault of their own, they ended up with an out-of-network radiologist or anesthesiologist."
Senator Yee´s SB 697 will explicitly prohibit a health care provider who is furnished documentation of a person´s enrollment in Healthy Families or AIM to seek reimbursement or attempt to obtain payment for any services provided to that person other than from the participating health plan covering that individual.
SB 697 will next be considered by the full Assembly.
