New law prevents out-of-network surprise billing

Jul 5, 2017

Patients who go to a hospital covered under their health insurance plan don’t have to worry about receiving surprise bills anymore, thanks to a California law that took effect July 1.

Tam Ma with advocacy group Health Access says patients can now rest assured that they will only have to pay their regular co-pays or deductibles when visiting an in-network hospital.

“Going in to have a surgery, or some kind of procedure, is already stressful enough. There’s already a lot of paperwork associated with it. We are glad that consumers now have one less thing to worry about,” Ma said.  

Prior to the law, patients were going into hospitals covered under their plan and finding out later that an out-of-network anesthesiologist or radiologist had treated them. Doctors are now prohibited from billing patients in these situations.

Instead, insurers must pay out-of-network doctors the same rate as doctors in the network, or 125 percent of Medicare rates, whichever is higher.

Many doctors’ groups came out against the bill, saying it will lower their payments. Prior to the law, out-of-network doctors could bill patients for their services, even though the patient was in a hospital covered under their plan.