California Court Upholds Rules Prohibiting Balance Billing
On Wednesday, a Sacramento Superior Court judge ruled that the Department of Managed Health Care has the authority to bar doctors from participating in balance billing, upholding a disputed regulation prohibiting the practice that took effect in October, the Los Angeles Daily Journal reports (George, Los Angeles Daily Journal, 12/4).
Oftentimes, balance billing occurs when insured people are treated in hospital emergency departments by doctors who are not included in the patients' health plans' preferred networks.
Insurers reimburse doctors and hospitals at a lower, out-of-network rate, and the health care providers bill patients for the remainder of the charges (Calvan, Sacramento Bee, 12/4).
The California Medical Association, the California chapter of the American College of Emergency Physicians and other groups filed the lawsuit (California Healthline, 10/14).
Ruling Details
In his ruling, Sacramento County Superior Court Judge Michael P. Kenny denied a request for injunctive relief and dismissed arguments by doctors groups that DMHC had exceeded its authority.
Kenny did not take a stance on whether the new rule would unjustly benefit health plans or hurt health care providers.
Reaction
In a prepared statement, DMHC Director Cindy Ehnes said, "Our legal authority to protect consumers from bills they should never have received has now been confirmed."
Francisco Silva, general counsel for the California Medical Association, said the ruling will undermine the state's emergency medical system because it will leave doctors with unpaid bills and minimal recourse.
Silva said his group will likely appeal Wednesday's decision.
Supreme Court Ruling Expected
The ruling could be superseded by the California Supreme Court, which heard a similar case centered on balance billing last month.Â
According to the Daily Journal, a ruling in that case is expected "within weeks" (Los Angeles Daily Journal, 12/4).
Broadcast Coverage
On Wednesday, Capital Public Radio's "KXJZ News" reported on the ruling (Weiss, "KXJZ News," Capital Public Radio, 12/3).
Other States
Outside of California, balance billing has sparked regulatory action in Illinois and New York, the Wall Street Journal reports.
The Journal profiles several cases of balance billing and provides tips for patients to avoid being balance billed (Wilde Matthews, Wall Street Journal, 12/4). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.