Last week, California Senator Ted Lieu introduced Senate Bill 1373 requiring more transparency in medical billing in response to a radio investigation revealing how patients are being billed for services they were unaware of. Unexpected billing commonly occurs when patients receive care from a provider outside of their insurance network or for services not covered by their plan. The bill requires providers and hospitals to disclose all treatment costs and patients will be given notice if they are going to be treated by a physician from outside of their network.
Medical providers and hospitals must disclose to patients when a service, procedure or supply is out of the patient’s coverage plan or insurance network.
The disclosure rule positively impacts the medical accounts receivable departments across the state, as patients are understandably reluctant to pay for services and procedures not covered by insurance that they were unaware of. With the disclosure, patients can refuse services that they will have to pay out of pocket.
As part of that disclosure, providers must provide an estimate of the cost of the service, procedure or supplies.
Knowing in advance the projected cost of health care services allows them to decide for themselves if they want to incur the charge for seeing an out-of-network doctor.
Payment for services out of network is to be paid for by the health insurer or plan unless the patient “reasonably should have known” that the service performed was by someone not in their network.
By purposely seeking treatment outside of their provider insurance network, patients can be billed directly and reduce the time put into claims submission that will end up going nowhere. If the patient chooses the out-of-network doctor on their own, billing staff can have the patient pay with cash or a credit card at the time of service or set up automatic debit installments to be paid after the service or procedure.