CA SB1373

Hospitals must provide written notice to patients seeking elective or scheduled procedures if covered by point-of-service or preferred provider organization plans, stating that hospital-based providers (radiologists, anesthesiologists, pathologists) may be out-of-network and may not be covered, with estimated costs provided in English, Spanish, Vietnamese, Chinese, Korean, Tagalog, Russian, Armenian, Khmer, Arabic, or Hmong.

Hospitals must obtain patient or legal representative signature on the notice before rendering services for elective or scheduled procedures.

Health care service plans and health insurers must either authorize enrollees or insureds to obtain covered services from a noncontracting provider or refer them to a contracting provider with similar clinical expertise in the same geographic region when a referral request is made based on the hospital notice.

Hospitals and provider groups are prohibited from holding themselves out as being within a plan or insurer network unless all individual providers are in-network or the hospital or provider group acknowledges that individual providers may be outside the network.