New York Did It, Florida Too: Now California Puts Limits on Surprise Medical Bills

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New York Did It, Florida Too: Now California Puts Limits on Surprise Medical Bills

Sep, 29th 2016

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills. AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers during or because of a stay at an in-network facility. The law limits cost sharing for covered services to in-network amounts unless the patient consents in writing to receive care from a noncontracting provider. The law passed the California legislature with broad bipartisan support.

The law defines how much health plans and insurers must pay noncontracting providers for covered services. Under its formula, noncontracting providers are entitled to the greater of the average contracted rate or 125% of the Medicare fee-for-service rate for similar services in a similar geographic area. The law also requires State insurance...

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