Beginning next year, most California residents won’t have to worry about those surprise bills that arrive weeks, and sometimes months, after calling for an ambulance during emergencies, says a state lawmaker.
The law will also require state-regulated health care plans and insurers to reimburse patients for such services at an authorized rate and establishes a maximum rate for those who are not insured.
It also increases visibility and transparency of rates by publishing the allowable maximum rates that can be charged in each county.
The new law takes effect Jan. 1, 2024.
Patients often get the “surprise” bills, not knowing they were being served by an out-of-network ambulance company, according to Ms. Boerner. Consumers don’t have a choice when the ambulance arrives and it’s not covered under their plan, she said. This often results in the patient paying for charges their health plan doesn’t cover.
California has 715 public and private ambulance services statewide, with 3,600 licensed ambulances, according to the California Health Benefits Review Program, an independent organization that provides legislative analysis of health insurance benefits in the state. There are 337 emergency ambulance service areas, of which more than 220 are served by private ambulance companies.
People spend about $2 billion for ambulance services in California each year, according to the benefits review program. Health plans often set their allowable costs for such services much lower than what the companies charge, leaving patients on the hook.
The new law also ensures ambulance providers will have their costs better covered by requiring that health plans pay them at rates negotiated and set locally through city or regional governments.
Health Access California, a statewide health care consumer advocacy coalition, which sponsored the bill, said Californians will finally be protected from the extra costs.
“We’ve heard from Californians across the state who have been hit with these unexpected bills when a family member needed an ambulance,” said Katie Van Deynze, policy and legislative advocate for the coalition. “People think it’s a mistake because they have insurance, only to find out that California law allows these large bills to be charged to consumers, and they have to figure out how to pay for it.”
Some patients may even decide not to call an ambulance for their next emergency, according to the group.
The California Association of Health Plans, the Association of California Life and Health Insurance Companies, and America’s Health Insurance Plan opposed the measure saying the bill would increase health insurance premiums statewide by over $67 million a year.
