Controversial S.F. General Billing Practice Faces Statewide Ban

San Francisco legislators don't expect smooth sailing in order to outlaw high bills for insured ER patients statewide.

A controversial hospital billing practice is on the chopping block statewide, made famous by insured San Francisco ER patients charged tens of thousands of dollars.

State legislators representing San Francisco introduced a bill on Monday that would ban hospitals from charging insured emergency room patients high bills at rates higher than their copay or deductible. Zuckerberg San Francisco General Hospital has been put on blast in recent months for sticking insured ER patients with high bills not significantly covered by their insurers, a practice known as balance billing. Insurance companies and hospitals are expected to challenge the bill with amendments as it moves through the California Legislature.

“This really is one of those outrageous situations in our healthcare system where people who did nothing wrong are being harmed,” said state Sen. Scott Wiener, a cosponsor of proposed solution AB 1611. “This legislation will help protect all patients so that no one has to go into debt or bankruptcy due to a health emergency.”

California already has some of the country’s strongest protections for out-of-network emergency patients but leaves out a small sliver of health insurance plans, leaving about seven million Californians vulnerable. S.F. General is out of network for all private insurance plans but people are often sent there for its renowned emergency care.

Stories first reported by Vox highlighted people like Nina Dang, who was billed $24,000 after being sent to S.F. General for a broken arm during a bicycle accident and spent months caught between the hospital and her insurer while trying to recover. At a Government Audit and Oversight Committee hearing on Thursday, S.F. General representatives disclosed that five to six thousand people face bills of this nature that can also harm credit scores.

“The physical aspects were easy compared to dealing with this bill on my own,” Dang said at the Monday press conference. “It really disrupted my life for eight months. I started to doubt myself thinking I did something wrong.”

Supervisor Norman Yee shared similar sentiments. A driver hit him in 2006, leaving him the hospital for close to a month and with a more than $100,000 bill while he wasn’t sure he could work again. At Thursday’s hearing, he teared up as he said he thought his family would go bankrupt and ultimately had to hire a lawyer to settle the bill.

S.F. General, which put a 90-day hold on the practice, indicated it would likely bill insured ER patients based on income and try to remove patients from payment negotiations with insurance companies altogether. But if Chui, state Sen. Scott Wiener and Assemblymember Phil Ting are able to get AB 1611 passed, balance billing would be eliminated altogether. Plus, insurer payments to hospitals would be limited to the greater of 150 percent of the Medicare or its average contracted rate. 

Wiener doesn’t expect the bill to slide through the legislative process and is looking to hear from hospitals like S.F. General that may be concerned about collecting proper payment from insurance companies. Through working on AB 1611, Wiener’s office heard from Tennessee Sen. Lamar Alexander, who chairs the Senate’s health committee and is interested in similar reform on a federal level.

“My hope is that Congress will also take action,” Wiener says. “Those safety nets should not be funded on the backs of San Francisco residents who received 20, 30, 50 thousand dollar surprise bills. That’s not how you fund a public health system.”

Tags: , , , , ,

Related Stories