California Regulators Try Again To Write Ban on Balance Billing
On Monday, the Department of Managed Health Care will meet with insurers in San Diego as part of an attempt to develop rules to bar the practice known as balance billing, the San Diego Union-Tribune reports.
Balance billing surfaces most often when patients seek care from emergency departments outside of their health plans' networks of contracted providers.
Balance bills average about $300 for patients, according to the California Association of Health Plans, a trade group representing health insurers (Darcé, San Diego Union-Tribune, 5/17). In a 2006 survey, CAHP found that Californians who visited EDs since 2004 received $578 million in bills for unpaid balances, in addition to their copayments and deductibles.
In 2006, Gov. Arnold Schwarzenegger (R) ordered state regulators to ban balance billing, but DMHC has not yet finalized regulations (Costello, Los Angeles Times, 5/17).
The current round of hearings is DMHC's third attempt over the past two years to reach a consensus among insurers, physicians, hospitals and other stakeholders over new rules on balance billing.
The current proposal lacks provisions for an independent dispute-resolution process and a method for calculating fair charges for hospital and physician services, the Union-Tribune reports.
A final version of the agency's proposal is expected to be released in the fall.
Supporters of the proposed regulations said a balance billing ban is overdue.
Michael Russo of the not-for-profit California Public Interest Research Group in Los Angeles said insurers, doctors and hospitals must resolve their disagreements without involving patients.
Ted Mazer, former president of the San Diego County Medical Society, said DMHC should require insurers to pay a portion of the disputed bills up front and then use historical data to determine the appropriate charges (San Diego Union-Tribune, 5/17).
Meanwhile, Kaiser Permanente on Friday obtained a temporary restraining order from Los Angeles Superior Court against Prime Healthcare because two of Prime's hospitals had sent ED bills to about 6,000 Kaiser members.
The order bars Prime from collecting payments from patients and from reporting the bills to national credit agencies until a court hearing in June (Los Angeles Times, 5/17).
Prime contends that Kaiser failed to pay for more than $25 million in services after concluding that some patient conditions did not constitute real emergencies (San Diego Union-Tribune, 5/17).
Kaiser also is involved in separate litigation over balance billing with Cedars-Sinai Medical Center, the Times reports (Los Angeles Times, 5/17).