"Health Care Consumer's Out-of-Network Protection, Transparency, Cost Containment and Accountability Act."
The act is designed to provide a framework for handling billing disputes, creating two peer review programs—one for physicians and another for healthcare facilities. These panels will assist in resolving conflicts surrounding balance billing, with a structured approach rather than an all-or-nothing arbitration method. The legislation aims to reduce the financial burden on consumers following unexpected out-of-network costs, while ensuring that all healthcare providers are kept informed about the networks in which they operate, particularly in self-insured plans where third-party administrators may complicate billing transparency.
Assembly Bill A1390, known as the Health Care Consumer's Out-of-Network Protection, Transparency, Cost Containment and Accountability Act, seeks to address ongoing issues in the healthcare delivery system by enhancing consumer protections against unexpected out-of-network charges, often referred to as surprise billing. The bill mandates that healthcare providers disclose their network participation status during the scheduling of non-emergency services, allowing patients the option to choose between participating or non-participating providers. If a patient opts for a non-participating provider, they must receive a written estimate of costs and consent to any potential additional charges not covered by their insurance.
While proponents argue that this act will lead to greater transparency and reduced instances of surprise billing, concerns have been raised regarding its implementation. Critics fear that mandatory disclosures may complicate service delivery, particularly in emergency situations where immediate care is necessary. Furthermore, health care providers express concerns regarding potential financial impacts on their operations, mainly if reimbursements do not align with the costs of providing services. Additionally, there is apprehension that this scrutiny of out-of-network billing might inadvertently lead to higher insurance premiums for consumers as insurers account for potential losses stemming from balance billing cases.