Vital Times 2020 - 24

Specifically, AB 2157 provides the following:
1.	 Ensures that information submitted through
the IDRP must be kept confidential from either
disputing party.
2.	 That the independent arbiter conducts a " de novo "
review of the claim dispute based solely on the
timely information and documents submitted into
evidence by the parties.
3.	 That the independent arbiter assigns reviewers
to each case based on their relevant education,
background, and medical claims payment and
clinical experience.
Since physicians keep patients safe while undergoing
complex surgeries and other procedures that require
high levels of sedation, CSA believes that no patient
should ever worry about receiving a " surprise bill "
from their anesthesiologist. As most of you recall, in
2016 California passed AB 72 (Bonta) (Chapter 492),
which rightfully removes patients from the middle
of these contact and billing disputes between health
plans and/or insurers and physician should they
receive services from an out-of-network provider in an
in-network facility.
AB 72 was also intended to encourage physicians,
health plans and/or insurers to negotiate fair
and reasonable contracts in order to maintain an
adequate network of physician services and ensure
access. However, as it pertains to anesthesiology
services, the pendulum swung too far in favor of
health plans, insurers, and their delegated authorities.
In fact, a growing number of anesthesiology groups
have indicated that since AB 72 was enacted, health
plans, insurers, and their delegated authorities have
been demanding significant reductions in their
reimbursement rates or they will simply terminate the
contract - which has nearly led to situations where
there are no anesthesiology services available at innetwork facilities. This behavior is not only completely
counter to the intent of AB 72, but has the potential to
severely impact, diminish, or entirely eliminate patient

24 |

CSA Vital Times

access to anesthesiology services at contracted innetwork facilities.
AB 2157 helps strike a fair balance between keeping
patients out of the middle of these contract disputes,
while at the same time maintaining the integrity of
the IDRP established by AB 72.
A special " Thank You " goes out to the CSA District
Directors and members throughout the state who
engaged in an effective grassroots advocacy
outreach campaign and participated in targeted
" virtual " legislative district meetings with key
members of the Legislature to educate them about
the importance of AB 2157. In particular, CSA District
Directors Lawrence Ong, MD, Jeffrey Rusheen,
MD, Robin Seaberg, MD, FASA, Sydney Thomson,
MD, FASA, Christian Borhringer, MBBS, and Henry
Gonzalez, MD, were instrumental in leading virtual
meetings with their local legislators. Additionally, CSA
greatly appreciated the involvement of so many more
members who wrote letters or who joined legislative
outreach phone calls as local constituents to provide
additional grassroots support - including Folu Ani,
MD, Robert Wong, MD, Puja Trivedi, MD, Jim Hlavacek,
MD, Ellen Wang, MD, Larry Sullivan, MD, Michael
Champeau, MD, FASA, Chien Chow, MD, FASA, as
well as President-Elect for CSA Ron Pearl, MD, FASA,
Director of the CSA Early Career Practice Forum
Sunny Jha, MD, Director of the CSA Early Career
Practice Forum and Felipe Perez, MD, Vice Chair for
the CSA Legislative Affairs Committee.



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https://www.nxtbook.com/allen/csvt/vital-times-2021
https://www.nxtbook.com/allen/csvt/2020
https://www.nxtbook.com/allen/csvt/2019
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https://www.nxtbook.com/allen/csvt/2017
https://www.nxtbook.com/allen/csvt/2016
https://www.nxtbook.com/allen/csvt/2015
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