BILL ANALYSIS Ó
AB 533
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ASSEMBLY THIRD READING
AB
533 (Bonta)
As Amended April 23, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+--------------------|
|Health |17-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Rodriguez, | |
| | |Santiago, | |
| | |Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+--------------------+--------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
AB 533
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| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: This bill establishes requirements for the payment of
non-contracting individual health professionals when a health care
service plan enrollee obtains services from the non-contracting
professional in a contracting health facility, as specified.
Specifically, this bill:
1)Prohibits, when an enrollee or insured individual in a health
care service plan or health insurance policy, who receives care
at a contracting health facility from a non-contracting
individual health professional, to pay more than the in-network
cost sharing.
2)Requires a health plan or insurer to inform the non-contracting
individual health professional of the in-network cost sharing of
the enrollee or insured upon time of payment.
3)Requires a non-contracting individual health professional to
refund any amount collected from the enrollee or insured that is
greater that the in-network cost sharing; and, requires the
refundable amount to accrue interest, as specified, if it is not
returned to the enrollee or insured within prescribed time
limits.
4)Prohibits a health plan or insurer from paying a non-contracting
individual health professional if the professional has advanced
AB 533
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the amount owed by the enrollee or insured to collections, prior
to payment by the plan, as specified.
5)Provides that any cost sharing paid by the enrollee or insured
provided by the non-contracting individual health professional
shall count towards the annual out-of-pocket expenses limit and
the enrollee's deductible.
6)Allows an enrollee or insured to voluntarily consent to the use
of a non-contracting individual health professional contingent
on specified consent and cost estimate requirements.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)One-time costs, in the range of $300,000 (Managed Care Fund), to
the Department of Managed Health Care (DMHC) for plan review,
legal services, technical assistance, and regulations.
2)Ongoing annual costs potentially in the hundreds of thousands of
dollars (Managed Care Fund), to the DMHC Help Center to assist
consumers, and investigate and resolve complaints and disputes.
3)One-time costs of $300,000 (Insurance Fund), to the California
Department of Insurance (CDI) for policy review and regulations.
4)Ongoing annual costs, in the range of $50,000 (Insurance Fund),
to CDI to assist consumers, and investigate and resolve
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complaints and disputes.
COMMENTS: The author states that this bill will protect patients
who do the right thing by seeking care in an in-network facility,
only to later receive a surprise bill from an out-of-network
provider that had been called in to provide service. The author
states that surprise bills cost consumers substantial sums of
money, placing an undeserved and unreasonable financial burden
upon them. The author asserts that consumers should not be placed
in the middle of billing conflicts and disputes between
out-of-network providers and plans or insurers, particularly when
they sought in-network care but were seen by an out-of-network
provider through no fault of their own. The author contends that
while California has been at the forefront of the federal Patient
Protection and Affordable Care Act implementation, we need to
catch up to other states which have taken the lead in fully
protecting consumers from surprise bills. The author concludes
that it is the state's responsibility to ensure full consumer
protection for all of our patients, and this bill ensures patients
are safeguarded from hidden costs unfairly imposed upon them when
they have followed the rules.
Health Access California, the sponsor of this bill, and other
supporters state that surprise billing practices are a result of
both inadequate provider networks and a lack of disclosure
regarding provider status and billing to consumers prior to
procedures taking place, and asserts that health plans and
providers should not involve consumers in business disputes.
Supporters state that consumers who follow their plan's rules and
use in-network facilities should not be surprised by
out-of-network charges from providers who grant care at in-network
facilities. The California Association of Health Plans, and some
health plans have a support if amended position based on an older
version of the bill, and state that the easiest solution for
balance billing is for doctors to contract with health plans and
carriers.
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The California American College of Emergency Physicians and some
specialty provider groups are opposed to this bill, stating that
patients and providers should be protected from health plans and
insurers who do not have adequate networks, by imposing a payment
standard on health plans and insurers set by an independent,
unbiased, non-profit entity. The opposition argues this bill
provides health plans and insurers more opportunities to collect
premiums from patients, not provide the care they have agreed
give, and pay physicians arbitrary amounts. The California
Medical Association and California Society of Anesthesiologists
have an opposed unless amended position based on a previous
version of the bill, and state an efficient, equitable dispute
resolution mechanism will guide parties towards a reasonable rate
of services.
Analysis Prepared by: An-Chi Tsou / HEALTH /
(916) 319-2097 FN: 0000726