September 04, 2014
Area(s) of Interest: Access to Care Advocacy
The California Medical Association (CMA) has defeated a bill that would have imposed unfair contracting conditions on physicians and exacerbated the state's current network adequacy concerns. The bill (AB 2533) would have required health insurers to arrange for, or assist in arranging for, out-of-network care for enrollees who are unable to obtain medically necessary care or services from a network provider, at no additional cost to the patient. Unfortunately, vague language in the bill could have been interpreted to require out-of-network providers to accept the contract reimbursement rates of the plan and it explicitly prohibited them from billing enrollees for any amount in excess of the in-network reimbursement rate.
CMA opposed the bill because it would hurt physicians that choose not to contract with plans or specific networks and it would all but eliminate any economic motivation for health plans or providers to contract to maintain and build adequate health plan provider networks.
Without the motivation to contract, health plan network adequacy problems would be exacerbated, undermining the intent of the bill, which was to ensure that health insurers and health plans provide timely access to health care for their enrollees.
CMA built a coalition to defeat this bill that included the American Congress on Obstetricians and Gynecologists, the Association of Northern California , the California Psychiatric Association, Osteopathic Physicians and Surgeons of California, California Academy of Family Physicians, CalDerm, California Society of Anesthesiologists, California Podiatric Medical Association, California College of Emergency Physicians, American Academy of Pediatrics and the California Academy of Eye physicians and Surgeons.