Below in an excerpt from Health Access. Read the full report here.
AB 72 took effect on July 1, 2017, and now, over two years later, the data is clear: The law is working as intended by consumer advocates, protecting patients from physician balance billing, while ensuring a fair payment to providers (key focus of negotiations) where the compromise benchmark payment is based on the average contracted rate. California’s health system protects patients while continuing to provide access to care to needed care without any empirical evidence of negative impacts from AB 72.
Highlighting the most recent data from state regulators, this report shows:
- Patients are being protected from surprise medical bills from out-of-network physicians.
- All but a handful of physicians are accepting the “average contracted rate” benchmark as payment in full, rather than appealing and making their case for higher payment.
- According to state regulators and health plans, insurers have broadened their networks, and contracting continues to be widespread such that 80%-100% of their hospitals
and other facilities have no out-of-network billing from the physicians practicing within.
Key lessons can be learned from California to inform federal action. California’s experience also highlights the need for federal action to fully hold consumers harmless, protecting them from surprise bills and medical debt, regardless of their insurance plan.
Read the full report here.