On July 1, 2017, a new law (AB 72) will take effect that will change the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law, signed in 2016, was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. 

The California Medical Association (CMA) has published a number of resources to help physicians navigate this new system, including an FAQ, instructions for obtaining patient consent, a sample consent form and an overview of billing requirements under the new law. These resources are available free to members only at Out-of-Network Billing.

CMA also recently hosted a members-only webinar on the new out-of-network billing and payment law, which is now available for on-demand viewing.

CMA is working hard to ensure health plans and insurers do not game the system to pay artificially low reimbursement rates to physicians. We need all doctors to take action by contacting the health plan/insurance regulators to express the importance and potentially negative impacts of this law if not implemented correctly.

Additionally, if your practice has experienced a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or is experiencing other challenges, CMA wants to hear from you.