Thursday, October 6, 2016

AB 72 (Bonta) targets physicians but leaves insurance companies and MPNs unscathed


Governor Brown signed AB 72 (Bonta) to put a stop to "surprise billing" but he left intact the ability of Medical Provider Networks (MPNs) and insurance companies to skimp on medical coverage, for instance, by not retaining enough specialists. When the MPN's patients then need the specialist that the MPN can't provide, "out-of-network" specialists are summoned. The "out-of-network" physicians, since they're not in-network, may bill at higher rates than the MPNs -- this practice has resulted in unpleasant surprises to patients when they learn that the medical bills they're getting are higher than expected because the specialist called in at the last minute was "out-of-network." This practice ends with Bonta's legislation which targets doctors but spares MPNs. Here's the scoop: the MPN purposefully retains too few doctors, especially specialists, in order to avoid paying "in-network" specialists. This desultory practice is known as "network contraction" or "in-network sharing." It allows more of subscribers' premium payments to be used for increased executive compensation instead of for patient care. Bonta's bill could have fixed this aspect of the problem along with the smack-down on "surprise billing." Only Bonta didn't want to ruffle the feathers of the insurers and MPNs. This writer recommends for legislative year 2017 that CMA, CSIMS, CNS, and UAPD seek legislation requiring MPNs to field fully staffed networks so that "out-of-network" doctors are no longer needed. The legislation needed would require that MPNs be fully  staffed or else -- the or else would be dissolution of the MPN for non-compliance.




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