CALIFORNIA – Governor Gavin Newsom signed AB 716, last month, a law that protects insured and uninsured Californians from high out-of-network ambulance fees.
“For ambulance rides, California patients often receive a surprise bill of over $1,000 and even more than $2,000 depending on the provider and insurer,” said a Health Access California AB 716 Fact Sheet.
The nonprofit says as a result, many Californians may not call 911 for legitimate fear of the ambulance bill – putting their health at risk.
Starting January 1, Californians with state-regulated health insurance who receive covered services from an out-of-network ground ambulance provider will pay no more than they would pay for the same services from an in-network ground ambulance provider.
In addition, the new law says out-of-network ground ambulance providers can only send to collections the amount allowed that the consumer has failed to pay – not the out-of-network amount.
The law also prohibits ground ambulance providers from billing an uninsured or self-pay patient more than the established payment by Medi-Cal or Medicare fee-for-service amount, whichever is greater.
Reimbursement to ambulance operators
The law ensures ambulance providers are reimbursed similar to how they are under existing local rate-setting processes – without the consumer being charged out-of-network fees.
When there is not a contract between the ambulance provider and the insurer or health plan, the health plan or insurer pays the ambulance provider the locally-set rate for ambulance services.
Filing a complaint
Consumers can file a complaint if they find that an ambulance operator is overcharging on a bill.
The new law requires insurers to tell consumers if a health plan is regulated by the state. If it is, the regulator is likely to be the Department of Managed Health Care. Contact them online at www.healthhelp.ca.gov or by phone at 1-888-466-2219.
If a health plan is regulated by the Department of Insurance, consumers can file a complaint online at https://cdiapps.insurance.ca.gov/CP/create-complaint-page/ or by phone at 1-800-927-4357.