Today's Law As Amended


PDF |Add To My Favorites | print page

AB-1670 Health care coverage.(2019-2020)



As Amends the Law Today


SECTION 1.

 Section 1371.85 is added to the Health and Safety Code, to read:

1371.85.
 (a) If a contracting provider identifies that a service sought by an enrollee is not a covered benefit, the contracting provider may bill or collect from the enrollee if the enrollee consents in writing, and that written consent demonstrates that all of the following are met:
(1) The enrollee consented in writing to receive services from the contracting provider at least 24 hours before the services were provided.
(2) The written consent is in a separate document from the document used to obtain consent for any other part of the service.
(3) The written consent was not obtained by the facility or a representative of the facility.
(4) The written consent was not obtained at the time of admission or at a time when the enrollee was being prepared for surgery or another procedure.
(5) At the time the written consent was provided, the contracting provider gave the enrollee a written estimate of the enrollee’s total cost.
(6) The enrollee was advised that the enrollee may elect to seek care from another provider or may contact the enrollee’s health care service plan to arrange to receive the service from a contracted provider for lower out-of-pocket costs.
(b) If a contracting provider identifies that a service sought by an enrollee is not a covered benefit, the contracting provider shall provide the enrollee with a written estimate of the enrollee’s total cost, based on the standard rate the provider would charge for the service.
(c) The contracting provider shall not attempt to collect more than the estimated amount provided pursuant to subdivision (b) without receiving separate written consent from the enrollee or the enrollee’s representative, unless circumstances arise during the delivery of services that were unforeseeable at the time the estimate was given and that require the contracting provider to change the estimate.
(d) The written consent and the written estimate provided pursuant to subdivisions (a) and (b) shall be in the language spoken by the enrollee, if the language is a Medi-Cal threshold language, as defined in subdivision (d) of Section 128552.

SEC. 2.

 Section 10112.85 is added to the Insurance Code, to read:

10112.85.
 (a) If a contracting provider identifies that a service sought by an insured is not a covered benefit, the contracting provider may bill or collect from the insured if the insured consents in writing, and that written consent demonstrates that all of the following are met:
(1) The insured consented in writing to receive services from the contracting provider at least 24 hours before the services were provided.
(2) The written consent is in a separate document from the document used to obtain consent for any other part of the service.
(3) The written consent was not obtained by the facility or a representative of the facility.
(4) The written consent was not obtained at the time of admission or at a time when the insured was being prepared for surgery or another procedure.
(5) At the time the written consent was provided, the contracting provider gave the insured a written estimate of the insured’s total cost.
(6) The insured was advised that the insured may elect to seek care from another provider or may contact the insured’s health insurer to arrange to receive the service from a contracted provider for lower out-of-pocket costs.
(b) If a contracting provider identifies that a service sought by an insured is not a covered benefit, the contracting provider shall provide the insured with a written estimate of the insured’s total cost, based on the standard rate the provider would charge for the service.
(c) The contracting provider shall not attempt to collect more than the estimated amount provided pursuant to subdivision (b) without receiving separate written consent from the insured or the insured’s representative, unless circumstances arise during the delivery of services that were unforeseeable at the time the estimate was given and that require the contracting provider to change the estimate.
(d) The written consent and the written estimate provided pursuant to subdivisions (a) and (b) shall be in the language spoken by the insured, if the language is a Medi-Cal threshold language, as defined in subdivision (d) of Section 128552 of the Health and Safety Code.
SEC. 3.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.