Health care service plans: reimbursement.
The changes proposed in AB 685 are designed to expedite the reimbursement process for health care providers and enhance transparency for patients. By mandating a quicker turnaround on claim payment, the bill aims to alleviate financial pressure on medical providers, especially in emergency care settings where timely payments are critical. Additionally, the requirement for independent medical reviews aims to ensure that claims are evaluated fairly and based on established medical standards, which could prevent arbitrary denials.
Assembly Bill 685, introduced by Assembly Member Maienschein, seeks to amend sections of the Health and Safety Code and the Insurance Code pertaining to the reimbursement processes of health care service plans in California. The bill proposes that health care service plans must reimburse complete claims, or portions thereof, no later than 15 working days after receipt, a significant reduction from the current 30 working days. Additionally, it would require health plans to secure an independent review from a board-certified emergency physician before denying claims for emergency services based on medical necessity or the absence of a medical emergency.
The sentiment around AB 685 expressed in discussions reflects a general support for improving patient care and provider reimbursement timelines. Advocates argue that the bill will lead to more prompt financial resolutions for emergency medical providers, enhancing the quality of care offered to patients. Conversely, some dissenters are concerned about the potential implications for insurance companies and the overall insurance market, fearing that these mandates could increase administrative burdens and costs for insurers.
Notable points of contention in the discussions around AB 685 include the impact of quicker reimbursement timelines on the financial stability of insurance providers and the feasibility of implementing independent reviews for every contested claim. Critics question whether the added burden on insurers will lead to increased insurance premiums or reduced options for consumers. Additionally, there is concern about the effectiveness of independent reviews in ensuring claims are handled appropriately without leading to further delays in care.