Legislation to stop exorbitant ER bills on hold
The attempt by two San Francisco politicians to stop hospitals around California from sticking patients who receive emergency care with outrageous bills is on life support.
Assemblyman David Chiu on Tuesday said he is holding back his bill that was inspired by news of San Francisco General Hospital’s unfair billing practices after intense lobbying from hospital CEOs around the state urging his colleagues to kill it.
The bill was supposed to be heard in the Senate’s health committee Tuesday, but Chiu said its passage would have required amendments making the bill worthless, and he wasn’t willing to move ahead with them.
Instead, he’s turning the bill into a twoyear piece of legislation, meaning it can be taken up
again in January. But that means the earliest Gov. Gavin Newsom can sign it is September 2020. And that means the 7 million Californians who have private insurance and yet are still at risk of big emergency care bills won’t see any relief for more than a year — if at all.
“It’s disappointing this couldn’t get done this year,” Chiu said. “But this doesn’t mean we’re done. It ain’t over.”
The legislation, cosponsored by State Sen. Scott Wiener, was a response to intense media coverage of S.F. General, the city’s sole trauma center, slapping privately insured patients with huge, unexpected bills.
Because S.F. General doesn’t contract with any private insurance companies, insurers could pay whatever portion of a patient’s bill they liked and the patients would get stuck with the rest.
The Chronicle reported myriad stories of these eyepopping bills, including a man charged $92,470 for an emergency appendectomy and another billed $24,259 for doctors checking out bumps and bruises after a minor motorcycle accident.
“When you first started writing about this, it was, ‘Oh, a couple stories,’ ” Chiu said, noting it quickly became clear the issue was more widespread when S.F. General officials acknowledged 1,700 patients were stuck with these bills last year alone. The hospital in April announced it would end balance billing.
But really, the issue affects far more patients than anybody knew. Chiu said there are 7 million patients in the state who have private insurance and yet, because of the details of their insurance policies, are at risk of receiving big, unanticipated hospital bills.
Chiu’s proposal would have banned “balance billing” on emergency care — meaning hospitals and insurance com
panies would have to work out an agreement and not stick patients with the rest. Hospital administrators did not have a problem with that part of the legislation.
They do strongly object to a second part of the legislation, which attempts to set standard rates for medical costs when a patient receives emergency care at a hospital with which his or her insurance company has no contract. Otherwise, Chiu argued, the bills can be seemingly pulled from thin air and be way too high — like the $92,000 appendectomy.
Even if patients wouldn’t personally be on the hook for those costs anymore, if insurance companies are billed that much, they’ll simply pass on the costs to all patients in the form of higher premiums, Chiu said.
“That’s like locking the front door and leaving the back door wide open,” Chiu said. “It’s useless to protect patients from receiving a large bill on the front end if hospitals can turn around and pricegouge them on the back end. The patient still loses.”
That’s the piece Chiu said he’s determined to figure out next year after his staff collects more harrowing stories of patients stuck with these whopping bills.
“We’re going after a practice that generates billions of dollars of profits for hospitals, and hospital CEOs waged an aggressive lobbying plan to protect those profits,” he said. “These are difficult conversations and take time to figure out.”
Jan EmersonShea, vice president of external affairs for the California Hospital Association, explained last month as the bill progressed through the Assembly that the group “fully supports” taking patients out of the middle of disputes between hospitals and patients.
But she said the idea of ratesetting for all hospitals around the state is a separate issue and not how the bill was originally promoted.
“It creates a lack of incentive for the insurance company to negotiate a contract with the hospital,” she said. “That provision, from our perspective, must be removed.”
Wiener said he’s confident progress can still be made next year because the issue is too important to drop.
“This bill is a huge lift and a huge fight,” he said. “The number of people impacted by this issue is much higher than any of us anticipated. It’s just going to take more time to work it out.”
Jeffrey Lance, a 35yearold graphic artist at video game developer Zynga who lives in Bernal Heights, said the bill’s shortterm death was “disappointing, but not surprising.”
What was surprising was the $54,908.35 that Lance owed S.F. General for an emergency appendectomy in September despite having insurance. After he told his story to The Chronicle, the hospital informed him he’d no longer be on the hook for the money.
But the scary experience made him realize how broken the country’s health care system is.
“You go to the hospital, you go to the insurance company and they just sort of bat you around and tell you to go talk to the other guy,” he said. “You don’t know how bad your insurance is until something happens.
“We need universal health care like in a modern, industralized society,” he continued. “It just feels like we’re well past time for that.”