Effective July 1, 2017, Assembly Bill 72 (Bonta) went into effect by protecting Californians from unexpected medical bills when visiting in-network facilities (i.e., hospitals, labs, and imaging centers).  No longer can providers who aren’t contracted with a patient’s health plan step into the operating room, for instance, and charge the patient more than the patient would have expected to pay an in-network provider. Furthermore, the patient can only be billed for his or her in-network cost-share, meaning in-network benefits apply to all providers seen, and services rendered, in an in-network facility.

Over the course of my career, I’ve had to help many clients understand and appeal surprise charges from out-of-network doctors, anesthesiologists, etc., who’ve charged patients separately from the in-network facility, and I have experienced this myself when receiving care.  With many/most Preferred Provider Organization (PPO) plans, there is a separate deductible that a member has to satisfy for care received from out-of-network providers, after which, there is less coverage than in-network providers, and the member can be “balance-billed” between what the insurance company pays and what out-of-network providers charge.  AB 72 goes a long way toward eliminating such surprise charges.

As always, it’s important to review the Explanations Of Benefits (EOB’s) you receive from your insurance company, to make sure that your benefits have been applied correctly, according to your plan.  This is a smart piece of legislation that will help prevent unsuspecting patients in California from getting charged more from out-of-network providers, at least not without prior written consent.

For more information, contact Rancho Mesa at (619) 937-0164.