California lawmakers in the Senate appropriations committee are slated to hear legislation Monday that targets balance billing, according to a San Francisco Chronicle report.
California already restricts providers from balance billing in emergency care situations. Under the state'snewly proposed bill, AB72, consumers who are unknowingly treated by out-of-network radiologists, anesthesiologists or other providers would only pay what they would for in-network physicians within their insurance network, according to a KPCC report.
The bill is supported on both sides of the aisle. However, physician specialty groups want AB72 to include provisions that require insurers to contract with enough of these specialists to ensure an "adequate network" for their members, according to the San Francisco Chronicle.
Kasabian Evans, spokeswoman for the California Association of Health Plans, has said insurers "want to make sure any legislation doesn't provide a disincentive for contracting and make it harder for health plans to get fair prices for consumers in their contracted rates," the publication reported.
The practice of balance billing refers to a physician's ability to bill patients for outstanding balances after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by in-network rate agreements, have the ability to bill patients for the entire remaining balance.
Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money than expected for a medical service.