Calif. surprise medical bill law boosts number of in-network docs

A state’s efforts to eliminate surprise medical bills have paid an unusual dividend—more in-network physicians willing to participate.

A state’s efforts to eliminate surprise medical bills have paid an unusual dividend—more in-network physicians willing to participate.

Since California passed its legislation (AB 72) to end surprise medical bills in 2016, the number of in-network doctors has increased by 16 percent, according to a new study published by America’s Health Insurance Plans in the American Journal of Managed Care.

Critics of the bill had raised concerns that the law may cause insurance providers to reduce the number of specialty doctors in their networks, but AHIP argues that its study shows otherwise.

For the study, AHIP analyzed data from 11 health plans, representing 96 percent of covered lives in the fully insured commercial market in California. Research results suggest that, after adoption of the law, the number of physicians in provider networks was 116 percent of the level prior to the law going into effect.

AHIP gathered data from the health plans surveyed for the study on the total number of in-network providers between July 1, 2017, and July 1, 2019, for the following categories.

· All physicians regardless of specialty
· General surgery
· Emergency medicine
· Anesthesiology
· Diagnostic radiology
· Pathology

The results showed that on average, the number in-network specialty doctors either remained flat, or increased by as much as 26 percent, AHIP says.

The survey excluded health plans that had fewer than 10,000 enrollees, as well as Kaiser Permanente—even though it is the largest health plan in California, Kaiser Permanente was excluded from the study because it provides most care through its own physicians, AHIP says.

At least one in five Americans will receive a surprise medical bill from a doctor they didn’t—or couldn’t—know was out of their healthcare coverage network, according to AHIP. Most surprise medical bills are arbitrary, come from select specialty doctors and bear no relation to market rates or the actual cost of services provided. Federal legislation is necessary to protect patients by prohibiting surprise medical bills and requiring a reimbursement to providers that is market-based and fair, AHIP contends.

“Too many hardworking families are hit with a surprise medical bill after they get the care they need,” says Jeanette Thornton, senior vice president for product, employer and commercial policy for AHIP, which praises the study. “This study shows that we can protect patients, improve affordability and ensure strong provider networks with the right legislation to stop surprise medical bills.

“AB 72 is protecting patients and improving affordability, while ensuring that patients can get the care they need,” Thornton says. “Lawmakers at the federal level can adopt policies similar to AB 72 to make certain that every American patient gets the quality care they deserve at a price they can afford.”

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