In a California Healthline Special Report by Deirdre Kennedy, representatives from two physicians groups and the state Department of Managed Health Care discussed a Sacramento Superior Court ruling that upheld DMHC regulations prohibiting balance billing. 

The practice typically occurs in emergency department situations when patients are treated by physicians who don’t contract with their plan.

The Special Report includes comments from:

• Don Crane, president and CEO of the California Association of Physician Groups;
• Elena Lopez-Gusman, director of government affairs for the American College of Emergency Physicians; and
• Lynne Randolph, spokesperson for the state Department of Managed Health Care.

Physicians are divided on the issue. The California Association of Physician Groups applauds the ruling, while the American College of Emergency Physicians and California Medical Association oppose the rules.

“Balance billing is the symptom of a larger problem,” said Elena Lopez-Gusman (Kennedy, California Healthline, 12/11).

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