California officials are considering new rules that would ban balance billing for ED services, due in part to struggles over the fees charged by emergency department doctors, radiologists and anesthesiologists. These physicians, in particular, haven't been satisfied with what the hospitals' managed care plans pay, and have been billing patients for the difference between what the insurer pays and what they charge. Though patients often pay the bills, legally the insurer is supposed to pay the provider for all but whatever co-pay the patient has agreed to in their contract. On orders from Gov. Arnold Schwarzenegger (R), the state's Department of Managed Health Care has been trying to work out a compromise between insurers and providers on the issue for two years, but has gotten nowhere.
Now, the DMHC has decided to handle the issue on its own terms, issuing new draft regulations prohibiting billing for services that are the responsibility of the health plan. Meanwhile, angry doctors say that this could result in their sending the entire bill to the patient in an attempt to force the patient to deal with the mess.
To learn more about the balance billing issue in California:
- read this Los Angeles Times piece
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