Zuckerberg San Francisco General Hospital on Wednesday, Dec. 5, 2018. (Kevin N. Hume/S.F. Examiner)

Controversial ZSFGH billing practice that left privately-insured owing thousands could be banned

Publicity over “balance billing,” a practice that at Zuckerberg San Francisco General Hospital has left some patients with insurance on the hook for thousands of dollars in bills, has prompted San Francisco lawmakers to call for a ban.

SF General made headlines recently for being out of network with all private insurance companies and charging its insured patients high bills — in one case $20,000 for a broken arm — without informing them first of the practice.

Assembly Bill 1161, introduced by Assemblymember David Chiu and state Sen. Scott Wiener, would mandate that insured patients across the state owe the same copayment or deductible they would normally pay for their in-network emergency care.

The ban would apply regardless of whether or not the emergency room is in-network or out-of-network with a patient’s insurer.

Patients receiving non-emergency care already benefit from protections of a similar state law. However, the law does not apply to Preferred Provider Organization (PPO) patients.

Some 6 million people across the state have federally regulated self-insured plans, and some 1 million have plans regulated by the California Department of Insurance who don’t benefit from this protection, per the bill.

The bill, which is co-sponsored by Health Access, a statewide health consumer group, and the California Labor Federation, would also limit payments from insurers to hospitals “to the greater of 150 percent of Medicare or the average contracted rate,” regulating prices charged by hospitals for their care.

“At the heart of what we are trying to do is to ensure that if you or are a loved one are in the ER, the only thing you should be thinking about is how to get better and not about the bill for that care,” said Chiu.

He said that the bill is a response “in regard to what we learned is happening at [ZSFGH] — but also across California — this is the situation of patients who get a surprise bill after visiting an emergency room.”

San Francisco supervisors recently called for a hearing on the issue, at which several ZSFGH patients attested to financial difficulties they are now facing due to rather minor health complications that resulted in ER visits.

Nicki Pogue, for example, told the supervisors that she spent five hours at the hospital for a “viral syndrome” and was billed for $13,000, of which her insurance covered just over $3,000.

Earlier this month, the practice of balance billing was suspended at ZSFGH for 90 days and hospital officials were directed to come up with a better billing plan.

SEE RELATED: ZSFGH could cap payments for patients privately insured patients

Rachael Kagan, a spokesperson for the San Francisco Public Health Department, which manages the hospital, said in a statement on Friday that the department can’t comment on the proposed legislation but that “we absolutely agree that there is a role for policy changes to improve patients’ experience with billing,” including “local state and federal efforts.”

She added that the hospital and department are working in the meantime on making improvements. One proposal so far suggests capping out-of-pocket payments made by insured patients receiving emergency services, as was previously reported by the San Francisco Examiner.

lwaxmann@sfexaminer.com

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