California Regulators Proceed With Prohibition on ‘Balance Billing’
Despite lawsuits from the California Medical Association and other groups, the Department of Managed Health Care is proceeding with rules to bar "balance billing," the Los Angeles Times reports.
The rules are scheduled to take effect today (Girion, Los Angeles Times, 10/15).
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 (California Healthline, 10/14).
DMHC Director Cindy Ehnes said she is moving forward with the rules because of the burden that balance billing places on consumers.
Rundown of Cases
CMA and other groups have sued the department in hopes of blocking the rules from taking effect.
Next month, the California Supreme Court is scheduled to hear a lawsuit that DMHC filed against Prime Healthcare Services, a Victorville-based hospital chain.Â The department alleges that Prime improperly billed insured patients for fees that health plans declined to pay (Los Angeles Times, 10/15).
On Wednesday, KXJZ's "Capital Public Radio" reported on the rules (Weiss, "Capital Public Radio," KXJZ, 10/15).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.