Legislators in two states are introducing bills to stop surprise medical bills. 

California, Colorado Legislatures Introduce Bills to Block Surprise Medical Bills

Legislators in two states are introducing bills to stop surprise medical bills.

California

Vox reports: “California lawmakers will introduce legislation Monday to end surprise emergency room bills like those that left one patient with a $20,000 treatment bill after a minor bike crash — a move they say was inspired by Vox’s reporting on the issue.”

“The new bill, introduced by state Assembly member David Chiu and state Sen. Scott Wiener, would bar California hospitals from pursuing charges beyond a patient’s regular co-payment or deductible. The ban would apply even if a hospital was out-of-network with a patient’s health insurance.”

Vox adds: “There are two key parts to the proposal. First, the bill would prohibit hospitals from pursuing any balance that the patient owed beyond their regular co-payment or contributions to the health plan’s deductible.”

“Second, the bill would regulate the prices that the hospital could charge for its care, limiting the fees to 150 percent of the Medicare price or the average contracted rate in the area, whichever is greater.”

Colorado

The Times-Call reports: “While the Colorado Legislature for the past five years has attempted to address the issue by setting limits on how much out-of-network providers can charge, supporters believe this year’s bill has a good chance of passing under new Democratic leadership.”

The piece outlines two bills: “Currently, there is an out-of-network health care bill in each chamber of the Legislature. While both stipulate that health care providers must disclose whether a facility or a doctor is out of network and how that will affect the cost of services, the real sticking point is how to negotiate out-of-network prices.”

“House Bill 1174 calls for rates to be capped at the carrier’s median in-network rate for the same procedure in a similar facility, 200 percent of the Medicare rates for the same procedure in a similar facility, or 100 percent of the median in-network rate as determined by claims data from the Colorado All-Payer Health Claims Database, which the Legislature set up in 2010 to monitor health care costs throughout the state.”

“Senate Bill 134 lays out three similar options: the average in-network rate for the same procedure, 125 percent of the Medicare reimbursement rate for the same procedure, or 100 percent of the median in-network rate as determined by claims data from the Colorado All-Payer Health Claims Database.”

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