The Unintended Consequences of AB 716

On February 28, 2025, Robby Witt (@thesephew) recorded an interaction with a California hospital, customer service agent after a medical bill for an ER visit and ambulance more than doubled from $600 to $1,300 when the hospital applied his insurance to the bill.

His frustration is shared by the nearly 32.5 million “likes” on Instagram and TikTok in about 2.5 weeks.

This system seems to penalize patients who have insurance.

We were curious what counsel the MAC had for Robby's situation.

Have you experienced the Marshall Allen Clone yet?

Takeaways:

1. Prices are rarely transparent. Your price can fluctuate widely, depending if it is the negotiated rate your insurer agreed to, the cash price, or the discounted price due to regulation.
   

2. Medicare sets prices for hospitals and other health care services for their members. And its prices are usually much less than what commercial health insurance plans have negotiated to pay. In fact, hospitals can charge working Americans almost any amount, and you almost never get a price upfront.
   

3. Request an Itemized Bill: Always ask for an itemized bill with billing codes to verify the accuracy of charges.
   

4. Compare Prices: Use resources like Fair Health Consumer and Healthcare Bluebook to check if the charges are reasonable.
   

5. Ask for the Cash Price: Even if you’re insured, it’s worth asking if the provider will match the cash price. Some may agree if you persist.
   

6. Dispute Unfair Charges: If you believe your bill is unfair, dispute it in writing and provide evidence to support your case. Consult www.marshallallenproject.org/resources for the form letter MAC mentions in the video.
   

7. California Assembly Bill 716 was intended to halt surprise medical billing for people who might be hesistant to dial 911 in an emergency medical situation by providing discounts for uninsured patients but does not extend these benefits to insured individuals. Be aware of how this law might affect your bill.
   
   If you happen to be in California, Health-Access.org’s AB 716 Fact Sheet describes four ways California Assembly 716 was intended to work.
   
   For consumers with state-regulated plans: AB 716 prohibits ambulance providers from sending any bill beyond the in-network cost-sharing amount to patients or to collections. The in-network cost paid will count toward deductibles and out-of-pocket maximums for consumers.
   
   For ambulance providers: This bill ensures that they are reimbursed similar to how they are under existing local rate-setting processes, without the consumer being stuck with the surprise bill. The bill requires that when there is not a contract between the ambulance provider and the insurer or health plan, that the health plan or insurer pays the ambulance provider the locally-set rate for ambulance services.
   
   For the uninsured: To protect consumers without insurance from being billed the full locally-set rate for ambulance rides, AB 716 prohibits people without insurance from being charged a bill greater than the Medi-Cal or Medicare rate for the service, whichever is greater.
   
   Collections protections: For Californians both with and without insurance, the bill protects consumers who receive bills for ambulance services from having their credit adversely affected, wages garnished, or liens placed on their homes over the course of collections. Under this bill, out-of-network ambulance providers can only send to collections the amount allowed under this bill that the consumer has failed to pay, not

   the out-of-network amount. The bill protects consumers from being sent to collections, and having adverse credit reported for an unpaid bill or being sued within 12 months of the first billing.
   

Resources:

1. www.askthemac.ai is a great resource for before during or after your own healthcare interactions.
   

2. www.marshallallenproject.org/resources for resources like the form letter MAC mentions in the video
   

3. www.fairhealthconsumer.org and www.healthcarebluebook.com are great ways to compare your healthcare cots to industry prices
   

4. www.trybilly.app is a fantastic resource that shows you contracted procedure prices ahead of time, and gives you access to better pricing information when it comes time to settle your bill.