When it comes to navigating the intricacies of health insurance, Cassie Ray considers herself a pro. She actually reads her policy, including the fine print.

So when the 57-year-old from Fairfield, California, needed routine follow-up surgery after a mastectomy, she did her homework. “I looked up on my insurer’s network and made sure the outpatient facility that I was being referred to was in my network,” Ray said.

A month later, she received an unwelcome surprise: a $580 bill for an out-of-network anesthesiologist.

“I called the facility back, and at first, I felt like, this has to be a mistake. They’ll fix it,” Ray said.

Instead, the clinic said her only option was to negotiate the bill directly with the doctor. Ray’s experience illustrates the surprise of .

The unexpected charges come when patients are treated by an out-of-network provider at an in-network facility.

After several failed attempts in recent years, the California legislature passed , which aims to protect patients’ pocketbooks when they’re hit by these surprise bills. Gov. Jerry Brown has until the end of September to sign or veto the legislation. He is expected to sign it into law.

A 2015 Consumers Union suggests the surprise bill phenomenon is fairly common. It found nearly 1 in 4 Californians who’d had hospital visits or surgery in the prior two years reported receiving an unexpected bill from an out-of-network provider.

“They can range in price from a hundred dollars to many thousands,” said , special projects director for Consumers Union. “So it’s a big financial burden on consumers.”

In Ray’s case, she said she tried to speak with a manager at the outpatient clinic, but no one returned her repeated calls. Then the bills stopped coming, so she figured all was resolved. Soon after, however, her bill was sent to collections.

“I was so frustrated,” she recalled. “I was just in tears as I was dealing with it.”

Ray said it took about seven months of wrangling before her insurance company finally paid the bill and she was able to clean up her credit rating.

“My immediate response was, there does need to be a law to fix this,” said Ray. “This is so wrong.”

The legislation, by Assemblyman Rob Bonta (D-Oakland) and six colleagues, would limit a patient’s financial obligation to no more than what he would have owed if the provider had been in-network.

While agreeing that “patients should never have surprise bills,” Dr. Karen Sibert, president-elect of the California Society of Anesthesiologists, said her organization and a number of other specialty medical groups oppose AB-72.

At issue, Sibert said, is the bill’s formula for paying doctors who fill the gap left when insurance companies don’t have enough providers in their networks. The legislation would set the payment rate at either the amount the insurer normally pays a doctor on contract for such services or 125 percent of the Medicare rate, whichever is greater.

That’s insufficient, argued Sibert. “It’s a problem because it removes any incentive for insurance companies to reach fair contracts with physicians.”

Without such an incentive, she said, insurance companies will continue to have inadequate provider networks.

The powerful agrees with Sibert about the bill’s payment formula, but it has shifted its position on AB-72 from opposed to neutral, said Janus Norman, the Association’s vice president of governmental affairs.

There are a few reasons for the change of heart, he said. First, the bill would create stricter oversight of how in-patient services are delivered, and it would allow for tougher regulations on insurers if the state finds their provider networks to be inadequate.

The provision regarding tougher regulations, “is one improvement that AB-72 included that prior legislation did not,” he said.

In addition, the measure would give out-of-network doctors the chance to appeal payment disputes with insurers through an independent third party, and the decision would be binding, another important change from previous versions of the bill, Norman said.

The California Association of Health Plans and the Association of California Life and Health Insurance Companies don’t have a formal position on AB-72, according to an analysis by the Assembly Health Committee. Instead, they have expressed “concerns” about the measure, the committee said.

“While they laud the authors’ efforts to protect consumers from balance billing,” the analysis said, the insurer groups worry that the legislation might lead to higher premiums and cost-sharing, and that the bill’s dispute resolution process might spark more lawsuits between providers and health insurance firms.

Anthony Wright, executive director of Health Access California, a consumer health care advocacy coalition, said Gov. Brown took an interest in the legislation.

“The governor’s office did provide input during the negotiation process and we are hopeful that he will sign it,” he said.

Consumers Union’s Imholz said the California Medical Association’s neutral position on the legislation was key in getting AB-72 across the finish line.

She predicts that if Brown signs the measure, a number of other states now considering similar protections against surprise bills will likely follow suit next year.

This story is part of a reporting partnership with NPR, KPCC and .

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Five decades ago, two brothers helped start Medicare. Their father inspired them and they, in turn, have inspired the next generation.

To mark the anniversary of President Lyndon Johnson signing Medicare into law on July 30, 1965, three Lees sat down to reflect on the U.S. health care system.

It can be hard now to imagine a time when Medicare met serious opposition. But 92-year-old Dr. Peter Lee, a founder of the family medicine department at the University of Southern California, remembers that time well.

“I was one of the people who was supporting the idea,” he says. “And in response to that some people from the USC alumni association wanted me fired because they thought that was socialized medicine.”

The Los Angeles County Medical Association, too, called for Lee’s ouster. While Lee didn’t get fired, he did get called a lot of names. The same thing happened to his now 91-year-old brother, , who helped implement Medicare in the Johnson administration.

“They called me a socialist more often than a communist, but occasionally they referred to me as a communist,” he recalls.

Among those who did that, he says, was former President Ronald Reagan, who lent his voice to an ad by one of Medicare’s biggest opponents, the American Medical Association.

“One of the traditional methods of imposing state-ism or socialism on a people has been by way of medicine,” Reagan says in the ad.

The AMA opposed Medicare out of fear the government would become too deeply involved in the practice of medicine. But that didn’t sway the Lee brothers. Their work as ardent foot soldiers for Medicare, was borne in part from family legacy of health policy started by their father, Dr. Russell Lee, says his grandson Peter Lee.

“One of the things my grandfather did was he was involved in the Truman Commission, which in the 40s was one of the early reports generated to say we need national health care,” says the younger Peter Lee.

He went into the family business when he became a health policy expert. And he now runs Covered California, overseeing the largest expansion of insurance coverage in California since Medicare. His father, the elder Peter Lee, says the passage of Medicare changed the game. Before the law, the medical center where he worked was overflowing with elderly patients who had been discharged but needed some interim care before going home.

“So we always had patients in the hall,” he says. “Then Medicare was passed and then the halls were all empty.”

His son, Peter, explains, “They were empty because seniors all of a sudden had someone that would pay for long-term care that wasn’t there before. And it was a dramatic overnight change that affected millions of Americans.”

That’s because Medicare paid for, transitional nursing home care and other treatments for those 65 and older, no matter their income. Today Medicare provides health care for nearly every American 65 and older.

And the law prompted something else: the . Among those at the front line of that battle, the elder Peter Lee’s brother, Philip.

“Desegregation was critical,” says Philip Lee. “You couldn’t have a segregated medical care system.”

Philip Lee was sent to the South to make sure hospitals didn’t discriminate. He says it took the threatened loss of federal Medicare dollars to overcome resistance by many hospitals that ultimately integrated. And integration meant everyone and everything — from patients and staff all the way to the blood supply.

“And we made a lot of progress, even if it wasn’t perfect,” he says.

Today, both of the elder Lees say the biggest issues facing the nation’s health care system is making sure everyone gets medical care.

It’s a job that the younger Peter Lee says he’s taken on with inspiration from his family legacy and support from his father and uncle. And, he says, they set a high bar.

“It take persistence. It takes hard work. But change happens,” he says.

This story is part of a reporting partnership with , and Kaiser Health News.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .