• E-mail
• Print
• RSS

California to ban "balance billing"

Case Management Weekly, April 9, 2008

Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!

New legislation was drafted in California by the Department of Managed Health Care to stop physicians and hospitals from billing patients above what their HMOs are willing to pay, according to the LA Times.

The practice, called “balance billing,” usually involves emergency department physicians, radiologists, and anesthesiologists that work at the hospital but are not hospital employees. These physicians have different or no contracts with HMOs, and, arguing that HMO payments are inadequate, bill the patient directly for the difference. Many patients have paid these invoices, says the Times, thinking that they represent the co-payment for their HMO.

The drafted rules would prohibit physicians and hospitals for billing patients for the cost of ED services that are normally covered by the patient’s health plan.

Other states have passed legislation on this issue. In New Jersey and West Virginia, HMOs are required to pay the physicians’ rates, while Maryland has a formula to calculate what the reimbursement rate should be. In Connecticut, Colorado, and Rhode Island, legislation protects patients from having to pay these bills.

According to the article, insurers said that paying a higher rate to physicians and hospitals outside of their network would make being a part of the network less appealing.

Source: Los Angeles Times

Want to receive articles like this one in your inbox? Subscribe to Case Management Weekly!

• Comment
• E-mail to a Colleague
• Print
• RSS
• Archive

Comments