California recently enacted Assembly Bill 72 (“AB 72”) to target surprise medical bills from out-of-network professionals. The new law applies to commercial plans licensed by the Department of Managed Health Care and the Department of Insurance. AB 72 sets reimbursement rates for out-of-network professionals at in-network facilities at either the average contracted rate, or 125 percent of the Medicare Fee-for-Service reimbursement for the same or similar services. The constitutionality of these provisions has been challenged in federal court by the Association of American Physicians and Surgeons. AB 72 also implements a new dispute resolution process to resolve reimbursement disputes between commercial health plans/insurers and non-contracting health professionals that provide services at a contracted facility. Read the full client alert titled “New California Law to Curb Surprise Medical Bills Will Impact Relationships Between Health Plans and Non-Contracted Professionals,” here.
