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Committee advances bill to let medical providers challenge unauthorized discounts through IBR
Summary
AB 10 48, authored by Assemblymember Chen, would clarify that disputed unauthorized or contract‑based payment reductions for medical providers treating injured workers are eligible for Independent Bill Review (IBR). The committee voted to send the bill to Appropriations.
Assemblymember Chen’s AB 10 48 was advanced to the Appropriations Committee after committee testimony from physicians and medical associations seeking a route to challenge unexplained reductions to workers' compensation reimbursements. The bill would clarify that payment disputes involving unauthorized or contract‑based discounts may be reviewed through the Independent Bill Review (IBR) process.
Sponsors said third‑party or "silent" network arrangements sometimes apply discounts without a provider’s knowledge or valid contract, reducing reimbursements below official fee schedules and, in some cases, below Medicare rates. Dr. Basil Besh (transcript as "Dr. Basil Besch") and Diane Shapudiske of the California Orthopedic Association told the committee they had concrete cases in which providers were underpaid and could not get adequate explanations or contract copies.
Chen described a Southern California example in which an orthopedic surgeon expected $672.50 for a carpal tunnel procedure but received $548.54 after unexplained discounts. California Orthopedic Association testimony said one provider group was underpaid by about $500,000 before the contract basis for the discounts was produced.
Opponents—including the California Coalition on Workers' Compensation, public agency purchasers, insurers and business groups—said they supported transparency but questioned whether IBR is the correct forum and cautioned that some contracts already contain arbitration or dispute‑resolution clauses. Jason Schmelzer, representing the coalition, argued the proposal mixes contract applicability questions with the IBR's scope and could raise legal and procedural problems.
The committee moved and seconded the bill; the roll later recorded the measure as passed to Appropriations and ultimately recorded a committee tally of 17–0.
AB 10 48 would not change arbitration clauses, the sponsor said; it would simply make disputed payment reductions eligible for review via the existing IBR process to provide providers a disinterested adjudicative mechanism for disputes over unauthorized discounts.
The bill will next be considered by the Appropriations Committee.
