State Lawmakers Push to End Surprise Emergency Room Bills

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State Sen. Scott Wiener and Assemblyman David Chiu (at podium) announce a bill on Feb. 25, 2019 that would prevent hospitals from the practice of "balance billing." (Caroline Champlin/KQED)

Assemblyman David Chiu and state Sen. Scott Wiener, both of San Francisco, announced a bill Monday that would prevent public hospitals from charging emergency room patients whose insurance won't cover their medical bills. This practice is called “balance billing,” and according to Chiu, it’s costing Californians thousands of dollars.

Even if a patient has private insurance, an ambulance might transport them to an out-of-network hospital that doesn’t accept it — like Zuckerberg San Francisco General Hospital. Then, a month after getting treatment, they're hit with a surprise from the hospital.

“I got this atrocious bill for $13,000,” said Nicki Pogue, who was treated at SFGH after experiencing a severe reaction to bronchitis medication. To her shock, UnitedHealthcare would only cover $3,000 of the bill.

Pogue said she left the hospital within five hours, but spent the next five months trying to fight the charges.

“I went into the underworld of our health care system,” she said. Her weeknights and weekends were consumed by writing appeal letters, researching state legislation and talking to lawyers.

Ultimately, UnitedHealthcare covered her bill, but she’s not done campaigning yet.

“I will drive to Sacramento, I don’t care how many times, to make sure this bill gets passed,” she said.

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Pogue has been working with Chiu, Wiener, San Francisco Supervisor Norman Yee and other patients to rally for the bill, Assembly Bill 1611.  

She warns, “Until this bill passes, I don’t recommend anybody with insurance visit S.F. General.”

However, Chiu said choosing hospitals isn’t always easy.

“If you’re incapacitated or undergoing a life-threatening condition, you don’t have the ability or time to decide what hospital to go to,” Chiu said.

He said the problem of balance billing first came to his attention after Vox and the San Francisco Chronicle reported it last month.

“Until these stories surfaced, many of us had thought the practice of balance billing had been addressed by a decades old Supreme Court case and a 2016 California law,” Chiu said. In reaction to these news stories, ZSFGH said they’ve halted balance billing to review the policy.

Now, Chiu is searching for other public hospitals in California that might be balance billing. He expects it could be impacting millions of Californians. If it passes, AB 1611 will go into effect next year.