Embed from Getty Images

The Genesis

Nina Dang, a 24-year-old woman from San Francisco, faced a bike rider’s arch-nemesis: the pavement.

She told Vox, an online news site, that she fell off her bike last April, suffering a broken arm and a scratched face.

For her brief time at Zuckerberg San Francisco General Hospital and Trauma Center, Dang was charged $24,074.50. Her insurance agreed to cover $3,830.79 of the bill, leaving her with $20,243.71 to pay out of pocket, according to the Vox story.

Dang experienced what has come to be know as a surprise hospital bill.

These unexpected charges commonly happen when a patient receives emergency care from a out-of-network hospital.

To correct this problem, California Assemblyman David Chiu has introduced bill AB1611, titled Eliminating Surprise Emergency Room Bills. It would protect patients from these charges.

If it becomes law, AB1611 would guarantee a patient would only have to cover the copayment or deductible that they would pay for an in-network emergency care visit. It wouldn't matter if the hospital is out-of-network.

The Problem

Cases like Dang’s seem rare but actually are not. Someone who sustains an injury and needs emergency care and an ambulance ride generally goes to the closest hospital.

“Most people, when they go to the emergency room, they don’t have a choice of what hospital they go to. They could be badly hurt or unconscious," expalined Jen Kwart, the communications director for AB1611. "They will likely get taken to wherever the ambulance takes them.”
While many big hospitals honor most private insurance, Zuckerberg hospital does not.

Another California law, AB451, states if the patient had reasonable belief that the emergency care they received from a hospital was due to a real emergency, the patient's health plan is required to cover that care.

But the law does not make patients immune to surprise bills. A patient's insurance company still may not cover the entire bill.

The Solution

Chiu’s bill provides multiple protections for patients.

Kwart says it aims to protect patients from being hit with out-of-network costs in emergency situations. If a situation is deemed an emergency, it is up to one's insurance company and the hospital to negotiate the costs, leaving the patient immune to surprise bills.

Emergency patients would still have to pay any possible copay or deductible, but that would be it.

The bill would also protect insurance companies, making it illegal for hospitals to charge an emergency patients’ insurance company more if they have insurance greater than 150% of Medicare or the average contracted rate.

The Status

AB1611 has passed a policy committee and is set to be considered by the Appropriations Committee. The policy committee breaks down the bill and makes sure it is solid enough to consider, Kwart said.

The Appropriations Committee focuses on the fiscal implications of the bill and whether the passing of the bill will be financially possible.

The biggest opponent of the bill is the California Hospital Association. AB1611 would likely decrease hospital profits and create a bigger workload for hospitals, due to having to increase negotiations with insurance companies, Kwart said.

“We have to get through the Assembly, then the Senate, then the governor, so we have a long way to go. We feel pretty good about the bill,” she said.