Lawsuit Targets New California Rules Barring Balance Billing
On Sept. 26, the California Medical Association, the California chapter of the American College of Emergency Physicians and others filed a lawsuit in Sacramento Superior Court challenging new state regulations barring balance billing, the Los Angeles Daily Journal reports (George, Los Angeles Daily Journal, 10/13).
Oftentimes, 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, 9/12).
The Department of Managed Health Care's rules barring the practice are set to take effect on Wednesday.
Physician advocacy groups are working to block the regulations.
Francisco Silva, general counsel for CMA, said DMHChas overstepped its authority, arguing that DMHC's "job is to regulate HMOs and protect enrollees from HMOs, not to regulate doctors."
But state officials said they want to offer relief to consumers.
State regulators maintain that rules establish a process that permits ED physicians to seek payment without sending notices to patients.
DMHC Director Cindy Ehnes said, "It is important to remove the consumer from being used as leverage and substitute the department."
A hearing in the lawsuit filed by CMA and other groups has been scheduled for Nov. 21.
The state Supreme Court also is due to hear a case on balance billing -- Prospect Medical Group v. Northridge Emergency Medical Group -- in the coming weeks (Los Angeles Daily Journal, 10/13).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.