Every major healthcare reform ultimately comes down to one question: How will this affect patients?

Not insurance companies. Not attorneys. Not legislators. Not healthcare providers and physicians.

Patients.

That question should be at the center of every discussion about SB 623.

Much of the public conversation has focused on rideshare safety, transparency, billing practices, litigation, and reimbursement.

Those are important topics.

But another question has received far less attention: What happens if fewer healthcare providers are willing or financially able to treat lien-based personal injury patients?

The answer to that question may determine whether injured people receive the best care, timely care, delayed care, or no care at all.

Meet Maria

Maria is a 36-year-old single mother.

She is driving home from work when her vehicle is struck by a rideshare driver. Initially, she believes she is fortunate.

Nothing appears broken. The emergency department evaluates her and discharges her with pain medication and instructions to follow up with her primary care physician if symptoms worsen.

Two weeks later, she cannot sleep. Her neck pain has increased. She experiences headaches, numbness into her arm, and difficulty lifting her young daughter. Her employer notices she cannot perform many of her regular duties.

An MRI is recommended. Eventually, a pain management consultation. Perhaps surgery.

Maria has one problem. She has no health insurance.

Without lien-based care, she may have no realistic way to obtain the treatment her physicians recommend.

The Decision Happens Before the First Appointment

Many people assume access to healthcare depends primarily on medical necessity.

Medical necessity is certainly essential.

But providers must also evaluate whether they can responsibly accept the financial obligations associated with treatment.

A physician who accepts a lien patient assumes risk. A surgery center assumes risk. An imaging center assumes risk. An anesthesiologist assumes risk. A physical therapist assumes risk.

Sometimes those risks are manageable. Sometimes they are not.

Sometimes risks are transferable to insurance coverage. Sometimes they are not.

Every provider must make that decision before treatment begins.

Access to Care Is an Economic Issue

Healthcare providers enter medicine to help patients.

But every practice is also a business.

Employees must be paid. Equipment must be purchased. Facilities must be maintained.

Compliance obligations continue regardless of whether reimbursement arrives promptly or at all.

Personal injury medicine often asks providers to extend credit for the healthcare services performed.

Unlike traditional insurance reimbursement, providers may wait months and most likely years before payment.

Some cases fail. Some cases settle. Some proceed to litigation. Some result in reductions.

Providers understand those realities.

The question raised by SB 623 is whether changes in reimbursement expectations and financial risk may alter providers’ willingness to continue extending that credit.

That is not a legal question. It is an economic one.

Why Medical Funding Matters

Many people outside the personal injury industry misunderstand medical funding.

Some assume it exists simply to increase settlements. Others assume it benefits only providers.

The reality is more complicated.

Funding exists because someone must carry the financial burden while a personal injury claim moves through the legal system.

Sometimes that burden falls entirely on providers. Sometimes financing companies provide liquidity that allows providers to continue treating patients while awaiting resolution of the case.

Whether one supports or criticizes various funding models, they serve a practical purpose: They help bridge the gap between treatment today and payment tomorrow.

And medical funding companies who pay for medical procedures such as extensive surgeries let patients off the personal financial responsibility hook. They assume the risk of partial or no payment. That’s great for patient consumers and access to needed medical care.

If that bridge becomes more difficult to build, providers may become more selective about the patients they treat. And access to care will be more limited, the best of the best may withdraw, and in some cases, treatment options may be removed entirely.

Every Provider Asks the Same Question

Imagine four different healthcare professionals reviewing Maria’s case.

The chiropractor asks: “Can I devote months of treatment to this patient under these circumstances?”

The MRI facility asks: “Can we perform advanced imaging knowing payment may be delayed and even more uncertain now?”

The pain physician asks: “Can I schedule procedures that are expensive and now riskier?”

None of these providers is questioning whether Maria deserves care. They are asking whether they can assume the financial risk necessary to provide it.

That distinction matters.

The Biopsychosocial Consequences

This discussion extends beyond finances.

When medically necessary care is delayed, the consequences are not merely economic.

Trauma is rarely limited to one body part or even just the body. Delayed diagnosis may lead to prolonged pain. Delayed treatment may contribute to chronic disability. Unaddressed psychological symptoms may worsen.

Fear increases. Sleep deteriorates. Families and finances are stressed. Employment becomes uncertain. Relationships suffer. Life is significantly impacted.

The biopsychosocial approach to trauma-based care reminds us that trauma affects the whole person and has a whole life impact, not simply an injured shoulder, neck, or knee.

When access to timely care changes, the effects often ripple through every dimension of recovery and a patient’s life.

Could Provider Participation Change?

No one knows how many providers, if any, will reconsider accepting covered lien-based cases because of SB 623.

Some may continue exactly as before. Others may modify internal policies. Some may require different financial arrangements. Others may become more selective.

That uncertainty is itself significant.

Healthcare systems depend upon provider participation.

If participation declines even modestly, patients may experience longer wait times, fewer choices, or additional travel to locate willing specialists if any are even available.

Those are questions policymakers should continue monitoring as the law is implemented.

Measuring Success

Supporters of SB 623 will likely evaluate success by asking questions such as: Has transparency improved? Have inappropriate billing practices declined? Have litigation costs become more predictable? Have the number of nuclear and thermonuclear verdicts been lessened?

Those are legitimate questions.

Healthcare providers should ask another: Has access to the medically necessary care each patient needs been preserved?

Because a reform that succeeds financially but unintentionally reduces access to appropriate treatment deserves careful re-examination.

Likewise, a system that promotes access while tolerating abuse also requires improvement.

The challenge is finding the right balance.

The Goal Should Be Better Care

This should never become a debate about protecting one industry at the expense of another: Healthcare providers. Attorneys. Insurers. Transportation companies. Patients.

Each has legitimate interests.

The objective should not be to produce winners and losers.

The objective should be to create a system where patients receive timely, appropriate care. Providers are treated fairly. Attorneys effectively advocate for their clients. Insurers receive accurate documentation and reasonable charges and compensate fairly and timely.

Cases resolve more efficiently. Public confidence increases.

Those goals are not mutually exclusive.

The Question Worth Watching

As SB 623 moves from legislation to implementation, many issues will be debated.

Court decisions will interpret statutory language.

Providers will adapt. Attorneys will adjust. Funding companies will evaluate risk.

But perhaps the most important indicator will not be found in appellate opinions or legislative reports.

It may be found in waiting rooms or in consumer homes.

Will patients continue finding physicians willing to accept medically appropriate lien cases?

Will surgery centers continue providing access?

Will specialists remain available?

Will medically necessary care begin the moment it’s needed?

What impact will this have on people, healthcare systems, government and taxpayers over the long-term?

Those questions deserve careful attention over the coming years.

Because the success of any healthcare reform should ultimately be measured not only by what it costs…

But by whether injured people receive the care they need, when they need it.

Next in the Series

Today It’s Uber… Tomorrow It’s Everyone?

Could SB 623 Become a Blueprint for Future Personal Injury Tort Reform Nationwide?

In Part 8, we’ll step back from California and examine a broader policy question: when significant legal reforms prove workable in one setting, how often do they influence legislation elsewhere? We’ll explore historical examples, discuss why policymakers watch one another’s experiments, and consider what providers across the country should be monitoring in the years ahead.