Association between "Balance Billing" Legislation and Anesthesia Payments in California: A Retrospective Analysis

Area of Science:

• Health Economics
• Health Policy
• Anesthesiology

Background:

• Patients receiving out-of-network care may face balance billing.
• California enacted a law in 2017 to ban balance billing for anesthesia services.

Purpose of the Study:

• To examine the impact of California's 2017 balance billing ban on anesthesia care payments.
• To assess changes in in-network and out-of-network payment amounts and claim proportions post-legislation.

Main Methods:

• Utilized quarterly, county-level payment data from 2013-2020 for commercially insured patients in California.
• Employed a difference-in-differences analysis comparing anesthesia care payments to unaffected office visit payments.
• Defined policy significance as a 10% or greater change.

Main Results:

• A significant 13.6% decrease in out-of-network anesthesia payments was observed post-law implementation.
• In-network anesthesia payments showed a statistically significant 3.0% increase, but did not meet the policy significance threshold.
• The proportion of claims occurring out-of-network increased non-significantly by 10.0%.

Conclusions:

• California's ban on balance billing was associated with substantial reductions in out-of-network anesthesia payments within three years.
• The law demonstrated mixed results regarding in-network payments and the share of out-of-network claims, warranting further investigation.