As of January 1, 2024, California residents can breathe a little easier when it comes to unexpected ambulance bills. Assembly Bill 716, signed into law in 2023, addresses a significant issue that has plagued many patients: surprise bills from non-network ambulance providers. This bill introduces protections against “balance billing” for ambulance services, ensuring that Californians are not financially burdened by these unexpected charges. Here’s a breakdown of what AB 716 does and how it helps.
What is Balance Billing?
Balance billing happens when a healthcare provider charges a patient the difference between what the patient’s insurance covers and the provider’s total bill. For example, if your insurance only pays part of an out-of-network ambulance service, the provider could bill you for the remaining balance. This often leads to expensive surprise bills for patients, especially when they had no choice in selecting the ambulance provider during an emergency.
AB 716: Key Changes
AB 716 eliminates balance billing for ground ambulance services, protecting patients from being charged more than their insurance plan’s standard out-of-pocket costs. Here are the key changes the law brings:
1. In-Network Cost for Out-of-Network Ambulances:
If you use an out-of-network ambulance, you will only need to pay the same amount you would have for an in-network provider. This is called the “in-network cost-sharing amount.” It ensures that you are not financially penalized for something outside of your control, like the ambulance provider being out of network.
2. Protections Against Debt Collection:
The law prohibits non-network ambulance providers from sending unpaid bills to collections or taking legal actions (like wage garnishments or liens) against patients for at least 12 months after billing. This gives patients more time to sort out insurance disputes without the added pressure of collections agencies.
3. Caps on Uninsured or Self-Pay Patients’ Bills:
For those without insurance, AB 716 ensures that ambulance providers cannot charge more than the rate set by Medi-Cal or Medicare. This limits the potential financial impact on uninsured or self-paying patients.
4. Direct Reimbursement to Ambulance Providers:
Health insurers are now required to directly pay non-network ambulance providers the difference between the in-network cost-sharing amount and what is considered a reasonable rate for the service, depending on local regulations or industry norms. This provision prevents the patient from being caught in the middle of disputes between insurers and providers.
5. Annual Reporting of Ambulance Rates:
The law mandates that maximum ambulance service rates be published annually by the Emergency Medical Services Authority. This transparency allows for better oversight and ensures that patients, providers, and insurers have access to up-to-date cost information.
What About Self-Insured Plans?
It’s important to note that AB 716 does not apply to self-insured health plans. These plans, often offered by large employers, are governed by federal law under the Employee Retirement Income Security Act (ERISA), which preempts state insurance regulations. Because AB 716 is a state law, self-insured plans are exempt from its provisions unless they voluntarily choose to comply.
Self-insured plans are typically regulated at the federal level, so if you are covered by one, it’s important to check your plan’s specific policies regarding ambulance services. While AB 716 brings significant protection to many Californians, it does not automatically apply to everyone, particularly those covered by self-insured plans.
How Does This Help Californians?
AB 716 offers relief to patients who need emergency services, ensuring that financial concerns don’t add to the stress of medical emergencies. Here’s how:
– No More Surprise Bills: If you’re in an emergency situation and end up using a non-network ambulance, you don’t have to worry about being charged a huge out-of-network fee.
– Consumer Debt Protections: AB 716 offers critical safeguards against aggressive debt collection practices. It gives patients time to resolve billing disputes without the immediate fear of legal action.
– Transparency in Rates: By publishing ambulance rates annually, the law provides clearer information for consumers and insurers alike, reducing the chance of disputes and confusion.
A Step Forward for Patient Protection
AB 716 represents a significant step forward in making healthcare, especially emergency care, more affordable and less stressful for Californians. By addressing balance billing and setting clear rules for how non-network ambulance services should be billed, the state is working to reduce the financial burden on patients. However, if you are covered by a self-insured plan, be sure to check with your plan administrator as this law might not automatically apply to you.
In short, AB 716 ensures that when you need emergency transport, the last thing you have to worry about is an unexpectedly large bill. It’s a win for consumer protection in California.
Source: https://legiscan.com/CA/text/AB716/id/2844697/California-2023-AB716-Chaptered.html