What is California AB 72?

Assembly Bill 72 affords certain billing protections to individuals who are seen at an in-network facility for non-emergency services but, for one reason or another, are unexpectedly provided services by an out-of-network provider during the visit (California law already provides similar protections for emergency services).  Often, specialists that work within a facility, like anesthesiologists or radiologists, tend to be out-of-network providers, though patients are rarely notified of this fact.  If seen by an out-of-network provider during the visit, individuals can receive large bills for the full amount of services provided (instead of the in-network cost-sharing amount).

What protections are afforded under the bill?

  • The intention of the bill is to ensure that individuals who are seen at an in-network facility are only responsible for in-network cost-sharing amounts.
  • AB 72 ensures that payments made toward out-of-network bills will still be attributed to an individual’s deductible and maximum out-of-pocket limit.
  • Out-of-network providers in these situations are now prohibited from billing the individual until the insurance company relays the amount of the in-network cost-sharing.
  • Should a provider collect any more than the in-network amount, they will be forced to refund the amount to the patient within 30 days of receiving payment. If the refund is not provided, interest will accrue at 15% per annum beginning on the date payment was received by the provider.
  • The new law also protects the consumer from having their credit adversely affected, wages garnished, or liens placed on their primary residence to collect unpaid bills.
  • Providers may only send the in-network cost-sharing amount to collections if the consumer fails to pay.
  • For health plans with an out-of-network benefit, a consumer can choose to use an out-of-network provider by giving written consent 24 hours in advance of the out-of-network care.

Which policies does the new law apply to?

The law will apply to health care insurance plans or policies regulated by the State Department of Managed Health Care and the State Department of Insurance that were issued, amended, or renewed on or after July 1, 2017.

Additional Resources:

See the full text of the bill here.


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