Sen. Leland Yee: Cut Surprise Medical Bills

We are all aware of the dangers of not having adequate health insurance. When the unexpected happens, and the medical needs of you or someone you love require immediate action, the last thing you want to do is be caught worrying about if you can afford it.

However, even if you think you have health coverage, the risk of hospital visits bringing financial hardship is very real.

Through the practice of balance billing, hospitals and insurance companies manage to sidestep their obligations, and leave average people footing the bill. Balance billing threatens the health and financial stability of all Californians. This action is taken when your hospital and your insurance company disagree over which entity is paying for what service, and they decide instead to send the bill to the patient.

Oftentimes, this takes place because specialists within the hospital do not have contracts with insurance carriers. When this happens, instead of working it out between themselves, the bill gets sent to the patient.

Given that the patient just underwent a medical procedure, they are often not in a situation where they can deal with an unexpected fee, especially one costing thousands of dollars. By the time they return home, patients may face collection agencies demanding payment, or letters threatening them with legal action for their failure to pay bills they never expected to receive.

It is unacceptable that a patient who has health insurance prior to an operation can be saddled with the bill after the medical care is received. There is not a better time than now, as the Legislature is debating the best way to bring health care to the residents of California, than to combat this predatory practice, and the way to do so is through Senate Bill (SB) 389.

When patients play by the rules, they should be treated fairly, not hit with hidden fees and unexpected costs. This is why I authored SB389. The bill will force hospitals and insurance companies to resolve disagreements between themselves, rather than leaving the patient to pay the difference. If either party is unhappy with the arrangement, or if no settlement could be reached, then the matter would go to state regulators within the Department of Managed Health Care.

With a state entity acting as a mediator, hopefully many of these conflicts can be fairly and judiciously resolved.

The important fact is that the burden of navigating the complexities of a hospital's finances rests not with the patient, but with the trained professionals on both the hospital and the insurance carrier's staff.

Insurance companies sell peace of mind. Having health insurance allows the average person not to worry about how to deal with the unexpected. If these insurance companies are unable to cover the procedures that they claim to include, then the buck has to stop with them, not with the hardworking men and women who pay for their services.

I am confident we can get SB389 onto the governor's desk this session, and that we can protect consumers from being stuck with the bill.

Sen. Leland Yee is the assistant president pro tempore of the state Senate.