July 1 Law Change: California Now Offers Consumer Protections Against 'Balance Billing' Surprises on Fully-Insured Plans

From Kaiser Health News via Healthcare Finance:

California is among 21 states with consumer protections against balance billing, says Betsy Imholz, director of special projects for Consumers Union. But many states' protections are "quite limited," she says. 

"In some states, they only apply in emergency situations or for certain types of plans" such as HMOs, says Claire McAndrew, director of campaign strategy for Families USA, a national consumer advocacy group.

However, in a handful of states, including New York, Florida and now California, the laws are strong and comprehensive, McAndrew says. 

Under California's new law, if you visit an in-network facility -- such as a hospital, lab or imaging center -- you will be responsible only for your in-network share of the cost, even if you're seen by an out-of-network provider. 

The law applies to non-emergency services received on or after July 1. 

"This is a very big deal," says Tam Ma, legal and policy director for the advocacy group Health Access California. "We've heard from hundreds of consumers who were getting these surprise bills." 

A 2015 Consumers Union survey found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.