CMA President Says Bill Would Improve Enforcement of Contracts Between Providers, Health Plans

A proposed state bill (AB 1600) that would allow doctors to sue health plans over alleged violations of contracts is "highly needed ... if patients are going to get the care they need," John Whitelaw, president of the California Medical Association, writes in a Sacramento Bee opinion piece (Whitelaw, Sacramento Bee, 3/14). Whitelaw's opinion piece responds to a Bee editorial earlier this month criticizing AB 1600. The editorial said that the measure would make a "court case out of a run-of-the-mill money dispute between a health plan and a doctor" and "elevate" such disagreements "into legal cause of action in state court (after a mediation session that regulators may or may not require)" (Sacramento Bee, 3/3). Whitelaw says that current law is insufficient because while the Department of Managed Health Care has the authority to ensure that contracts between physicians and managed care companies are "fair, reasonable and sufficient to assure care," the agency refuses to take action "when an HMO contract provision violates the law." As a result, Whitelaw says, some medical groups and hospitals have started directly billing patients out of "desperation." He adds that many physicians are exiting managed care, and hospitals are having difficulty keeping emergency rooms "staffed and opened because of the difficulties in juggling unfair managed care contracts and patient needs." Whitelaw concludes: "DMHC officials have said they would be willing to work with the state agency for a third-party resolution" to disputes between doctors and health plans. "That's easy. This is exactly what AB 1600 aims to do. The legislation ... will clarify existing law and provide an enforcement process for patients and their physicians" (Sacramento Bee, 3/14).