California Legislations Passes to Protect Patients from “Surprise” Medical Bills
Under medical plan policies issued, amended, or renewed on or after July 1, 2017, patients who receive care in in-network facilities will have to pay only in-network cost sharing. Newly-signed A.B. 72 mandates that health plans pay non-contracting health care providers the plan's average contracted rate or 125% of the Medicare rate, whichever is greater. The new law also tightens requirements on health plans to offer adequate provider networks.
The new law applies to non-emergency care, since emergency physicians in California already are barred from balance billing patients. The bill's provisions do not apply to self-insured employer health plans, which are shielded from state regulations by the federal Employee Retirement Income Security Act.
The full text of the bill can be found here: AB 72 (PDF)