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CA AB 72 Puts Limits On Surprise Balance Billing

AB 72 passed both the California Senate and Assembly. It is has been sent to Governor Brown where he has until the end of the month to sign the bill into law or veto it. If patients are admitted to an in-network facility, there is a chance that one or more providers who provide patient care may not be in-network. If this happens, a patient may be billed directly from the out-of-network provider for the full amount of services. Under AB 72, for health plan contracts and health policies issued, amended, or renewed on or after July 1, 2017, the out-of-network provider will no longer be able to bill the full amount. Instead, the out-of-network provider would have to accept the average contracted rate, or 125% of the Medicare rate for same or similar services, whichever is higher. Additionally, patients would only be responsible for the same cost sharing required if the services were provided by a contracted provider. Some consumer advocates see AB 72 as a means to prevent surprise bills when patients are unaware that they were seen by an out-of-network provider at an in-network facility.

#balancebilling #physicianreimbursement #revenuecyclemanagement

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