Doctors, Medical Groups Debate ‘Balance Billing’ Regulations
The Department of Managed Health Care on Wednesday held a hearing to discuss proposed regulations that would ban doctors from billing patients for costs not covered by their managed care insurance plans, a practice known as "balance billing," the Sacramento Bee reports (Chan, Sacramento Bee, 10/5).
Balance billing usually occurs when a patient receives emergency services from a provider who does not contract with the patient's insurance company. If the insurer claims the medical bill is too expensive, the patient is charged for the difference between what the emergency department charges and what the insurer is willing to pay (California Healthline, 7/26).
Gov. Arnold Schwarzenegger (R) in July ordered DMHC to develop the regulations prohibiting the practice, create a benchmark for ED fees and establish a program to settle disputes between doctors and insurers. The final regulations are expected to be completed this year.
According to the Bee, insurers and medical groups endorsed the DMHC plan. Medical groups accuse ED physicians of overcharging and using balance billing as leverage to obtain those charges. The groups say that some physicians charge insured patients two to three times more than what they charge for Medicare beneficiaries.
Doctors are calling for an arbitration process to settle payment disputes. The physicians claim that health insurers are trying to pay the lowest rates possible to increase profits and that strict regulations against balance billing could make it difficult for hospitals to hire specialists willing to provide emergency care (Sacramento Bee, 10/5).