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Bills on Patient Choice, Holding Hospitals to Account on Charity Care


Specializes in Critical care, tele, Medical-Surgical. Has 49 years experience.

Two major bills sponsored by the California Nurses Association/National Nurses United that would greatly expand patient access to doctors and hospitals of their choice and hold non-profit hospitals to public accountability on what charity care and community benefits they provide passed key tests in the California legislature Wednesday.

On 6-2 votes, the Senate Health Committee approved both AB 2533 that would crack down on higher charges for patients who go outside their approved insurance "network" for medical care, and AB 503 to would combat the rampant abuse of what the hospitals report in how they provide charity care and community benefit programs in exchange for their tax exempt status...

... Patient Choice AB 2533, introduced by Assembly member Tom Ammiano, is especially timely, says CNA, for Californians who have just signed up for private insurance coverage through the Affordable Care Act's state health exchange, Covered California.

A major component of the bill is to require health insurers to arrange for enrollees who go outside their "approved" network of doctors or hospitals to obtain needed medical care in a timely manner will be charged the same out-of-pocket costs as they would pay for getting care within their network.

Addressing the committee Wednesday, Ammiano noted the bill "aims to protect patients for high out of pocket costs" when they need to go outside their limited insurance network. "Having an insurance card means nothing if you are unable to find a provider when you need it."

That tackles what CNA Co-President Deborah Burger, RN notes is "a gaping hole in the health insurance system that either limits patient choice, forces them to travel long distances to find a provider within their 'network' or exposes patients and families to excessively high bills that can lead to financial ruin." While the practice of imposing much higher costs on patients who seek care outside their limited networks is a long-standing abuse, the bill also responds to reports that some insurers in the new Covered California exchanges have set even more restrictive network limitations.

Speaking in support of AB 2533 Wednesday were the American College of Emergency Physicians Emergency, Health Access, National Multiple Sclerosis Society, League of Women Voters, California Association of Retired Americans (CARA) the Older Women's League, and the California School Employees Association.

Speaking against the bill, which has already passed the Assembly, was the insurance industry and the California Chamber of Commerce.

AB 2533 would also require health insurers to file annual reports on denials of care and complaints about timely access to care to the California Department of Insurance and Department of Managed Health Care and require the departments to post the information on their website for public review...