AB 72 wrongly rewards health insurance plans for carrying inadequate networks

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Sat Aug 20 13:15:50 PDT 2016


       

 

August 20, 2016

 

AB 72 wrongly rewards health insurance plans for carrying inadequate
networks 

 

 

California Medical Association

 

 

AB 72 (Bonta), a revised version of AB 533, would hamper physicians' ability
to effectively negotiate fair rates with health insurance plans by setting
out-of-network payments at a statutory default rate. Because of this set
rate, health insurance plans would be incentivized to drive down contracting
rates and likely unwilling to sign fair contracts. By mandating in law that
out-of-network providers are subject to the contracted rates of third
parties, AB 72 sets up a framework whereby health plans are incentivized to
carry exceedingly narrow networks. 

 

Description

 

The Senate is expected to consider AB 72 as early as Tuesday, August 16,
followed by the Assembly.

 

Talking Points

 

       .           I am opposed to the current version of AB 72. To provide
a better framework toward a comprehensive solution to the surprise billing
issue, amendments are needed to complete the legislation. 

       

       .           AB 72 needs to require health plans to provide in-network
providers at in-network facilities. Stronger network adequacy laws ensure
that health plans cannot use AB 72 as a way to drop contracts and carry
narrower networks, which dangerously limit patient access to care.

       

       .           The definition of "Average Contracted Rate" needs to be
clearly defined to prevent manipulation and must take into account discounts
currently provided for bilateral and multilateral procedures.

       

       .           In-facility consultations should be arranged by the
health plan. The health plan shall provide each facility with a list of an
in-network specialist with privileges at the facility where services are
needed to provide the consultation. 

       

       .           AB 72 sets out-of-network payments at the greater of 125
percent of Medicare or the average contracted rate. This statutory rate must
be the exemption and not the rule; otherwise, it incentivizes narrow
networks and will create downward pressure on the ability of physicians to
sign fair contracts.

 

Legislators need to hear from you! We ask that you and your colleagues CALL,
EMAIL or FAX your legislators, and urge them to oppose AB 72 unless amended!

Please ONLY contact your legislator (click
<http://findyourrep.legislature.ca.gov/> here to look up which district
you're in, if unknown). You can also download the Senate and Assembly Roster
with Counties for your reference.

 

Sample Letter

 

A sample letter is available on the
<http://cmanet.us1.list-manage.com/track/click?u=145aa039e469fec82f515d867&i
d=c425ad6233&e=7040f4c7a9> CMA website.

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service



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