Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.
Even in the hospital, Orsi dutifully wrote “no out-of-network doctors” across the top of Powers’ admission paperwork.
Her diligence was for naught.
Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.
The bills total about $5,600 – so far.
“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”
Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “balance billing.”
Under a new state law, if you visit an in-network facility – such as a hospital, lab or imaging center – you will only be responsible for your in-network share of the cost, even if you’re seen by an out-of-network provider.
The law applies to non-emergency services received on or after July 1.
“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group Health Access California. “We’ve heard from hundreds of consumers who were getting these surprise bills.”
A 2015 Consumers Union survey found that nearly one in four Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.
Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.
“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty,…