The stress of medical emergencies is already enough. You don’t need to add the worry of an unexpected bill. Assembly Bill 716, also known as AB 716, was introduced by the California legislature to protect patients who require ambulance service from unexpected charges. This law is important for anyone calling 911, whether it’s to protect themselves or their loved ones. It clarifies what health insurance providers and emergency medical services are responsible for.

Whether you have ever been in an emergency, you know there isn’t time to verify whether an ambulance service is covered by insurance. For this reason, it is critical to comprehend your rights under AB 716 for ambulance billing. This statute ensures that people in California who need emergency medical transportation aren’t surprised when they get bills from ambulance services that aren’t covered by their insurance. 

What Is AB 716, The Anti-Border Act?

AB716, passed in California, is a landmark piece that fills a longstanding hole in patient protection. Previously, patients who received ground ambulance services from providers outside of the network were billed at full price, even when they had insurance. Known as a “balance bill,” this practice often left patients facing unexpected medical debts in the hundreds or even thousands.

AB716 will protect insured individuals against these unexpected charges. The law applies to all commercial health care plans regulated or licensed by the California Department of Managed Health Care, CDI, or the California Department of Insurance.

Step 1: Understanding Patient Protections

AB716 provides specific protection to patients who need emergency ambulance services. Here’s everything you need to be aware of:

• There is no Balance Billing: The patient can no longer receive a bill for the difference between the ambulance service’s charges and the insurance provider’s payments. This protection will apply even if the ambulance service provider does not insure you.
• Cost-Sharing limits: You’re only responsible for the in-network cost-sharing amounts of your plan. This includes copay, deductible, and coinsurance. If you are required to make a $100 ambulance copay, you will only have to pay whether the ambulance service is part of your network.
• Emergency Services: These protections only cover emergency ground ambulance services. AB 716 doesn’t cover air ambulance or non-emergency transportation.

Step 2: Insurance Company Responsibilities

AB716 protects patients and imposes several duties on the health insurers.

• Timely reimbursement: Insurance plans must reimburse out-of-network ambulance providers fairly. While the law doesn’t set a set amount for reimbursement, it requires it to be done promptly and based on a reasonable value.
• Clear Communication: Insurers must inform patients transparently about their rights. They must also explain the coverage of emergency medical services and how to dispute a billing if necessary.
• Appeals System: If a client receives a bill violating AB716 protections, insurers must provide a clear and prompt process for internal appeals.

Step 3: Ambulance Provider Obligations

Ambulance services are subject to the same legal obligations as ambulance providers.

• Direct bill to insurance: Providers have to charge the patient directly and not through the insurance plan.
• No Collections Attempts: Providers may not attempt to collect any further charges after the patient paid their in-network cost-sharing amounts. The regulatory penalties could be severe if this is attempted.
• Cooperation for Dispute Resolution: If there’s a dispute about reimbursement, ambulance services must cooperate with the dispute resolution processes that state agencies or insurers have set out.

Step 4: What To Do When You Get A Surprise Bill

Despite the laws, billing errors or misunderstandings do happen. If you receive a surprise ambulance bill, follow these steps:

• Check Date and Provider: Confirm that the service occurred after January 1, 2023.
• Call Your Insurer: Ask your insurer for a breakdown of claims and check whether the service provider was in-network.
• Dispute Bill: If you feel you’re being charged more than you should for your cost-sharing in network, you have the right to lodge a dispute with your insurance company or state regulatory body (DMHC or CDI).
• Maintain Records: Documentation, such as bills, explanations (EOB), and communications with providers and insurance companies, should be saved.

AB716: Peace-of-Mind During Medical Emergencies

AB 716 marks a major advancement in Californians’ consumer protection. By eliminating unexpected billing for ground ambulance emergency services, this law reduces one of the major financial stresses associated with urgent health care. It allows patients to concentrate on receiving care rather than on understanding medical bills and navigating complicated insurance issues.

Understanding your rights as outlined in AB 716 can protect your wallet. It also gives you peace of mind knowing the law protects you during one of the most vulnerable times of your life. AB 716 protects your health and finances if you or a relative ever requires emergency transportation.