Bill > AB72

This bill aims to protect patients from unexpected out-of-network costs when they receive care at an in-network facility, by establishing new rules for health care service plans (like HMOs) and health insurers. Starting July 1, 2017, if a patient receives services from a doctor who is not contracted with their plan or insurer (a "noncontracting individual health professional") but is providing care at a hospital or facility that *is* contracted (a "contracting health facility"), the patient will only be responsible for paying the same amount of cost-sharing (like copays or deductibles) they would have paid if the doctor were in-network. This is referred to as the "in-network cost-sharing amount." The bill also creates an independent dispute resolution process for disagreements between providers and plans/insurers over payment for these services, and sets a minimum reimbursement rate for non-contracting providers at 125% of what Medicare pays for similar services, or the average contracted rate, whichever is greater. Importantly, these new rules do not apply to emergency services.