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Advocacy Group Offers These Tips For Coping With Surprise Medical Bills

LOS ANGELES ( — A bill aimed at ensuring that Californians pay only in-network fees if they go to an in-network facility is currently working its way through the California Legislature.

If passed, Assembly Bill 72 (AB-72) would require insurers to pay out-of-network providers in these hospitals at least 125 percent of the Medicare reimbursement rate for their services.

In exchange, doctors would be prohibited from billing patients out-of-network charges.

The bill is supported by the Consumers Union and Health Access California, and many health insurance companies. Primary opposition has come from physician's groups, including the California
Medical Association.

If you'd like to make your voice heard on the issue, you may contact your California senator, assembly member, or Gov. Jerry Brown, who is expected to get the bill on his desk next month.

In the meantime, the Consumers Union has offered the following advice on coping with surprise medical bills:

1. Remember there are protections in place already in California regarding emergency situations. Patients should be paying no more than in-network costs for emergency services.

2. Don't rush to pay a surprise bill. Rather, call the provider and call your plan and advocate to not pay. Sometimes it's a mistake, and sometimes providers will negotiate it down.

3. Before a surgery, make sure the hospital or facility is in-network. Call them both to verify your specific policy is in their network and press the surgeon/main doctor to use only ancillary providers (such as anesthesiologists) that are in your network. Some patients have handwritten that requirement into the papers they sign prior to a procedure, e.g.: "I only want services by an in-network provider."

4. Ask your doctor if they are in-network at every office/facility/hospital in which you may be receiving care. Make sure they are not providing your care at an out-of-network outpatient surgery center.

5. If you are unsuccessful in negotiating a medical bill on your own, state agencies may be able to help. You can request assistance through the California Department of Insurance. The phone number is 1-800-927-4357.

6. More resources from the Consumers Union are available by clicking here.

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