Committee forwards bill to let providers challenge unauthorized reductions through IBR

Assemblymember Selena Chen’s AB 10 48, which would clarify that disputed payment reductions applied without a provider's consent are reviewable through the Independent Bill Review (IBR) process, was passed to the Appropriations Committee.

The author said providers are receiving unexplained reductions—so‑called silent PPO discounts—that can be far below the statutory fee schedule and sometimes below Medicare rates. Chen gave a concrete example of an orthopedic surgeon expecting $672.50 for a carpal tunnel procedure who received $548.54 after an unexplained reduction. Physicians and specialty organizations said the lack of recourse is driving providers from the workers' compensation system.

Medical witnesses including Dr. Basil Besch and representatives of the California Orthopedic Association and the California Medical Association testified in support, urging that IBR is an existing, neutral process that can adjudicate disputed reductions and provide transparency by requiring carriers or third parties to show the contract that justifies a discount.

Opponents, including the California Coalition on Workers' Compensation, the California Association of Joint Powers Authorities, the American Property Casualty Insurance Association and the Chamber of Commerce, urged caution. Jason Schmelzer said his members view the matter as a legal contract question and questioned whether IBR is the right forum to adjudicate contract applicability; he also noted many contracts include their own dispute resolution processes (arbitration, venue selection).

The committee voted to pass AB 10 48 to Appropriations; later in the hearing log the bill was recorded as “out 17 to 0.” Supporters said they will continue to work with opponents on scope and implementation questions.