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After Vox story, California lawmakers introduce plan to end surprise ER bills

A new bill would outlaw the big, surprise bills that Zuckerberg San Francisco General Hospital has sent to hundreds of patients.

Bills and an emergency room hospital entrance. Christina Animashaun/Vox

California lawmakers will introduce legislation Monday to end surprise emergency room bills like those that left one patient with a $20,000 treatment bill after a minor bike crash — a move they say was inspired by Vox’s reporting on the issue.

The new bill, introduced by state Assembly member David Chiu and state Sen. Scott Wiener, would bar California hospitals from pursuing charges beyond a patient’s regular co-payment or deductible. The ban would apply even if a hospital was out-of-network with a patient’s health insurance.

“These practices are outrageous,” says Chiu, who represents part of San Francisco in the Assembly. “No one who is going through the trauma of emergency room care should be subsequently victimized by outrageous hospital bills.”

In January, Vox stories drew nationwide attention to the aggressive billing tactics used by Zuckerberg San Francisco General Hospital that could leave emergency room patients with overwhelming medical debt.

The problem is especially acute for patients like Nina Dang and Jason Zanders, both of whom were brought to the Zuckerberg San Francisco General Hospital by ambulance — Dang after a bike accident, and Zanders after being hit in the face with a pole hanging off a city bus.

Both Dang and Zanders have health insurance but didn’t realize that Zuckerberg San Francisco General Hospital was out-of-network for all private coverage — something that academic experts and patient advocates describe as an extremely unusual billing practice.

Dang ended up with a bill of $20,243, which the hospital reduced to $200, the copay listed on her insurance card, after our story about her experience. Zanders received a bill of $27,660 that he spent two years fighting in court.

Zuckerberg San Francisco General Hospital has, in light of reporting from both Vox and the San Francisco Chronicle, promised to revise its billing policies to be more patient-friendly. The hospital is reportedly considering a cap on charges for privately insured patients.

But Chiu thinks that even more action is needed: a statewide law that would outlaw this kind of behavior.

“This all came to my attention through your article,” Chiu said. “When your story broke, I started digging into how state law impacted the situation and saw that there were some clear holes in California policy that we needed to address.”

How California legislators want to end surprise emergency room bills

California actually has some of the country’s strongest protections against surprise medical bills, but the state’s laws never anticipated a hospital with billing practices like Zuckerberg San Francisco General.

In 2016, California passed a law that protected patients from surprise bills from out-of-network doctors they didn’t choose.

This might happen if, for example, a patient went to an in-network hospital and then received a bill from an out-of-network anesthesiologist or radiologist they never even met.

That law covered patients receiving scheduled care like surgery or delivering a baby. Separately, a decade-old California Supreme Court ruling provided similar protections for emergency room patients.

Neither the court ruling nor the 2016 law anticipated a situation like Zuckerberg San Francisco General, where the entire hospital is “out of network” with all private health insurance.

Most big hospital ERs negotiate prices for care with major health insurance providers and are considered “in network.” But Zuckerberg San Francisco General had not done that bargaining. Prior to Vox’s reporting, it had a longstanding policy of remaining “out of network” with all private health insurance plans.

A hospital spokesperson initially told Vox that the hospital’s focus is on serving those with public health coverage, even if that means offsetting those costs with high bills for the privately insured.

“It’s a pretty common thing,” Brent Andrew, the hospital spokesperson, told Vox in January. “We’re the trauma center for the whole city. Our mission is to serve people who are underserved because of their financial needs. We have to be attuned to that population.”

But most data finds that this isn’t a common practice: Academic researchers estimate that just 1 percent of emergency room visits happen at out-of-network facilities. Similarly, I’ve seen this in my own reporting. I’ve read more than a thousand emergency room bills, and in nearly all of them the facility is “in-network” with the patient’s insurance.

This new legislation would tackle that rarer situation where a hospital is not in network, and then sends the patient a bill for whatever balance their insurer won’t pay.

There are two key parts to the proposal. First, the bill would prohibit hospitals from pursuing any balance that the patient owed beyond their regular co-payment or contributions to the health plan’s deductible.

Second, the bill would regulate the prices that the hospital could charge for its care, limiting the fees to 150 percent of the Medicare price or the average contracted rate in the area, whichever is greater.

“Patients would no longer receive exorbitant, surprise bills,” Chiu said. “The discussion between insurers and hospitals would become far more predictable.”

Chiu said the hospital and insurance industries are aware of the effort but haven’t yet seen the full text of the legislation, which will be introduced on Monday.

Vox’s emergency room billing investigation has inspired multiple pieces of legislation — and reversed a half-dozen bills

The bills included in Vox’s reporting on Zuckerberg San Francisco General Hospital were all submitted by patients to our emergency room billing database, which has served as the basis for a year-long investigation into ER billing practices. Vox has collected more than 1,900 bills from all 50 states and the District of Columbia.

Vox’s reporting on emergency room billing has resulted in more than $92,000 in emergency room bills being reversed, including three from Zuckerberg San Francisco General Hospital. It has also inspired new legislation in the Senate to prevent these bills from happening nationwide.

You can read the rest of our series here — and if you’re a local reporter interested in writing about bills in our database, you can fill out this form, and we’ll try to help connect you with a patient.

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