There is a new Assembly Bill that affects the balance billing frequently done by anesthesiologists. This type of balance billing is not protected under the emergency visit balance billing law of 2009.
Recently California passed legislation on the balance billing that can take place inside of your visit at your neighborhood medical center. Several years back my client had severe abdominal distress. He went to the hospital without an ambulance. It was not coded as a life threatening situation. The attending physician called in a gastroenterologist who was not contracted with the facility and this member’s insurance. Several months later this gastroenterologist billed this member a large bill that was not in network, not discounted and was subject to the out of network deductible. This type of balance billing is most common with anesthesiologists.
Now California protects consumers with a new law called AB72. It is effective July 1, 2017. Some rules still apply: 1. The procedure needs to be covered by your insurance plan. 2. You need to be covered by that plan. 3. The facility you are at must be an “in network” facility 4. If you are on a MediCal HMO plan, this law will not apply.
Ambulance Rides can still hurt you financially.
In this day of smaller physician networks ( thanks to ACA ) out of the area hospitals are probably not covered as “in network” with your medical plan. Seven years ago, if you were hospitalized following an ER visit, the hospital could add thousands to your bill. The insurance company would pay “their share” and you were left holding the bill for the rest. California passed a law protecting people from this balance billing for emergencies. You can find dozens of stories regarding why this is a super law. This law missed the ambulance portion though. Ambulance companies can pretty much charge what they want after the insurance company pays the “in-network” amount. Generally insurance pays about 25% of the ambulance bill. There is nothing you can do and you will end up in collections if you do not pay. If you dig further, you will find out that cities think they have negotiated a contract with an ambulance company so that they keep charges fair and reasonable and yet other ambulance companies sneak in and charge what they want. Your best defense is to add medical to your auto insurance program if it pays for the ambulance up front. Add travel insurance when available and check the small print on the policy for ambulance rides. Your HMO plan will protect you with a set co-pay, however PPO plans do not.