California legislature passes bill to limit surprise billing

The California legislature is reported as having passed a bill to limit surprise billing at in-network facilities. Recently, people had reported shock at receiving out-of-network prices for procedures done at in-network facilities. This bill (AB 72) limits how much the out-of-network physician can charge; the rate would be the greater of the plan's average rate or 125% of Medicare's rate. Apparently, Consumers Union found that over the last two years, 25% of Californians were estimated to have been surprised by out-of-network rates.

Some doctors oppose bills like this because it gives insurance companies more leverage in pricing negotiations -- in theory, insurance companies would be less willing to agree to pay doctors more than 125% of Medicare's reimbursement. Regardless of how this might affect the relationships between providers and payers, patients benefit by having greater assurance of being charged in-network fees while at an in-network facility.