In April of last year, 24-year-old Nina Dang broke her arm as the result of a bicycle crash in San Francisco. She was taken by ambulance to Zuckerberg General Hospital. She received treatment and was later released to recuperate at home. Pretty routine, right?
Unfortunately, the story of Nina’s mishap on her bike didn’t end there. A couple months later she received a surprise medical bill for more than $20,000 from the hospital, even though she’s insured.
Nina, and millions of other Californians, are at risk of shocking ER bills from hospitals simply because of the type of coverage they have through their employer or union.
Who gets surprise ER bills? An estimated 7 million Californians are covered by federally regulated and self-insured plans — most often offered by large employers and union trust funds—or by plans regulated by the California Department of Insurance. These patients are not protected by a 2009 CA Supreme Court decision outlawing surprise ER bills. A loophole exposed millions of patients to ER bills that can run thousands of dollars.
How do we close the loophole and stop surprise ER bills? AB 1611 (Chiu) bans hospitals from sending surprise bills to patients for Emergency Room care beyond their regular co-payment or deductible. The ban would apply if a hospital was out-of-network with a patient’s health insurance. The consumer will only pay in-network cost-sharing and will not receive exorbitant bill. It also closes the loophole that left workers with self-insured or federally-regulated coverage through their job exposed to surprise bills.
Why is this a priority bill for unions? Many of our members are vulnerable to surprise ER bills. While union members often have good medical coverage, being taken to an out-of-network hospital after an injury or accident leaves workers exposed to sky-high ER bills. The legislation also eliminates inflated pricing from hospitals that drive up the cost of care for everyone. AB 1611 ensures fair payment for hospitals of 150% of Medicare or the average contracted rate, whichever is greater.
The bottom line: No one should get a surprise medical bill for tens of thousands of dollars. These bills add stress to patients who are trying to recover from illness or injury and leave workers on the brink of financial disaster. The legislature can close loopholes in current law and protect patients by passing AB 1611.