California takes a swipe at ‘surprise’ medical bills

California legislators took steps to eradicate surprise medical bills, which typically involves the specialties of pathology, anesthesiology and radiology. A measure passed by the state Assembly would forbid ancillary providers from charging patients more than the in-network rate for their specialty, if they delivered service at an in-network hospital. It’s now headed for the Senate, but as written, it’s opposed by the California Medical Assn. and some other provider groups. The issue has also gotten worse in recent years because insurers have been shrinking their networks and widening the gap between what they’ll pay for in-network providers and out-of-network care. Often the reimbursement in the latter case is nothing. The injustice, of course, is that patients typically have no control over the choice of their pathologist, anesthesiologist, or X-ray or CT scan provider; sometimes they don’t even know they’re being treated by one. The California bill would limit charges to patients in such situations to whatever the in-network charge would have been.  The problem this leaves is who’s going to eat the excess charge? That’s the core of the medical association’s problem with the bill. It’s asking that the measure be amended to “require an efficient, equitable dispute resolution mechanism that guides parties towards a reasonable rate for services,” in the words of an Assembly staff analysis. The California Medical Assn. says it favors the approach of a 2014 New York law, which requires arbitration between providers and insurers, leaving the patient out of it.