AB 72 Wrongly Rewards Health Insurance Plans for Carrying Inadequate Networks; Action Requested from Physicians July 27, 2016 Payment, Politics and Medicine, Public Health AB 72, health insurance 0 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. As the end of the legislative session nears, this bill is expected to move quickly. Please contact your legislators (both Senate and Assembly) and let them know that this bill, as written, is unacceptable. Your legislators need to hear from YOU now! We ask that you and your colleagues CALL, EMAIL or FAX your legislators, and urge them to oppose AB 72 unless amended! Phone calls are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided on the CMA website linked in the Take Action image below), which will greatly increase its impact. Click here to take action Click here to look up which district you're in, if unknown 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. Comments are closed.
