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Calif. Agents Postpone Patient Protection Battle

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NU Online News Service, June 15, 2004, 7:15 p.m. EDT – The California Association of Health Underwriter, Sacramento, Calif., says it will ask state lawmakers again next year to protect consumers from outrageous hospital specialty care bills.[@@]

Many lawmakers and interest groups, including the Western Center on Law and Poverty, Los Angeles, have supported Assembly Bill 2389, a CAHU-backed patient protection bill, but the Senate Health Committee bill docket appears to be too crowded this summer for the bill to get out the door, CAHU says.

A.B. 2389 would have required hospital preferred provider contracts to include provisions for payment of most of the non-network doctors who help them care for patients.

The amended version of the bill would have excluded emergency room doctors, but it would have applied to anesthesiologists, radiologists, pathologists and other hospital-based doctors.

CAHU sponsored the bill, which was written by Assemblymember Paul Koretz, D-West Hollywood, Calif., because many members have heard complaints from insured consumers about receiving huge, unexpected bills from out-of-network anesthesiologists, radiologists, pathologists and other specialists who helped care for them while they were in in-network hospitals, CAHU says.

Providers who sign preferred provider contracts usually agree to give up on “balance billing,” or trying to collect amounts over the standard rates negotiated with the carriers. If an in-network pathologist bills a patient for $10,000 but the preferred provider contract limits the charge to $2,000, the pathologist usually avoids trying to collect the additional $8,000 from the patient.

When doctors treat out-of-network patients, the doctors can balance bill the patients for any amounts not paid by the patients’ insurers. An out-of-network pathologist, for example, might collect $2,000 on a $10,000 bill from an insurer, then bill the patient for the remaining $8,000.

In many cases, hospitals, out-of-network specialists and health plans all fail to warn patients about the possibility that out-of-network providers might end up balance billing them, CAHU says.

The California Society of Pathologists, Sacramento, opposed A.B. 2389, calling it a “forced contracting mandate.” The California Healthcare Association, Sacramento, a major hospital trade group, also opposed the bill.