Urge Legislators to Oppose AB 533 September 3, 2015 General AB 533, Oppose AB 533 0 AB 533 (Bonta) would drastically change the current health care marketplace by transferring negotiating power to the health plans at the expense of physicians. The bill would require non-contracted physicians/providers to accept the “average contracted rate”—as determined by the health plan—when performing services in a contracted or “in-network” facility. In so doing, AB 533 would eliminate incentives for health plans to provide fair contract terms to physicians. This bill is now eligible to be heard on the Senate Floor! The California Medical Association is working with the California Society of Anesthesiologists, American College of Emergency Physicians, California Society of Plastic Surgeons, American College of Cardiology, California Society of Pathologists, California Radiological Society and the California Orthopedic Association to derail this bill. But we need your help! Your Senator needs to hear from you! We ask that you and your colleagues CALL, EMAIL or FAX your representative and urge them to oppose AB 533! Please contact ONLY your own legislator (click here to look up which district you're in, if unknown). You can also download the Senate Roster with Counties for your reference. Description The Senate is expected to consider AB 533, which would create a secret payment system controlled by the payors that cannot be verified or audited. This bill, an attempt to shield patients from billing disputes between providers and health plans, would create a de facto rate schedule for physician services, forcing non-contracted physicians to accept a plan-defined "average contracted rate" as payment in full for services provided at an in-network facility. Although CMA is in favor of removing patients from billing disputes between health plans and out-of-network physicians, this specific solution is unacceptable and gives too much power to health plans. If physicians are required to accept "average contracted rates" as defined by health plans, the plans have no motivation to contract with physicians. This not only eliminates physicians' abilities to negotiate fair contracts and payment rates, but also incentivizes plans to drive down contracted rates and maintain narrower networks—without any punishment for health plans that maintain inadequate networks. AB 533 would also discourage hospital-based and on-call specialists from accepting PPO patients. We ask that you and your colleagues CALL, EMAIL or FAX your legislators and urge them to oppose AB 533! Phone calls are most effective, but faxes and emails are important too. If you choose to fax or email your legislators, we strongly encourage that you personalize the letter (provided below), which will greatly increase its impact. Talking Points In its current form, AB 533 drastically changes the current health care marketplace by transferring negotiating power to the health plans at the expense of physicians. This entire bill is based upon the “average contracted rate,” as defined by the plans, with no opportunity for the physician to verify such data. Inadequate networks will further be encouraged because the hospital-based specialists that are the focus of the bill are not captured in the state’s current network adequacy or timely access standards. The use of an “average contracted rate” means that what rate the Health Plan negotiates with physicians will have a direct impact on what the plan is obligated to pay non-contracting physicians. This incentivizes health plans to drive down contracted rates and carry narrower networks, because AB 533 creates a structure that places all the negotiating power in the hands of the plan and creates no punishment for health plans that carry inadequate networks. Sample Letter A sample letter is available on the CMA website. Comments are closed.
