Health Care Stakeholders in California Face Off Over Balance Billing
California lawmakers are considering legislation aimed at "balance billing," a practice that health care stakeholders say is at the center of the debate on health care reform, Capitol Weekly reports.
Balance billing occurs when insured people undergo treatment at a clinic or hospital -- often in the emergency department -- that is not in their health plan's coverage network.
The health care provider bills the patient's health plan, but in some cases the insurer rejects the bill or pays only part of the charges. The health care provider then bills the patient directly.
Health plans, hospitals, physicians and patients often have different perspectives on the practice, as each group seeks to protect its own economic interests.
Estimates of balance billing charges in California range from $450 million to $527 million annually (Howard, Capitol Weekly, 3/20).