Here are three things to know:
1. SB 1478 would help patients avoid “surprise” insurance bills by establishing a minimum benefit standard with an amount equal to the 80th percentile of an independent, non-conflicted database of bill charges.
2. Out-of-network payment occurs when a patient receives a bill for the amount remaining between the out-of-network provider’s fee and the amount paid by the patient’s insurer after copay and deductibles. In most cases, this is the result of a gap between what the insurer chooses to pay and the physician’s billed charge.
3. Dr. Yen states that “the legislation effectively holds insurers accountable for providing an adequate network for all providers and services through, where in those instances that they fail to do so, making them issue payments based on real market values, therefore preventing patients from having to deal with grossly inadequate and surprise coverage.”
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