California Superior Court Upholds Balance Billing Regulations

Main Category: Public Health
Also Included In: Medical Practice Management
Article Date: 05 Dec 2008 - 1:00 PDT

email to a friend   printer friendly   opinions  

The California Superior Court today upheld regulations recently enacted state by the Department of Managed Health Care (DMHC) which protects patients from an unfair billing practice known as "balance billing."

"This is phenomenal news for every patient in California. It will ensure that patients don't get stuck with the bill when their medical providers can't agree on a sensible payment solution," said Donald Crane, President and CEO of the California Association of Physician Groups, which represents groups that employ or contract with nearly 60,000 California doctors and provide care to 15 million Californians.

"Today's court decision sends a strong message to anyone engaged in balance billing that this sharp practice has been officially declared to be unfair and that those that continue to do so face disciplinary action. We have long sought a prohibition on balance billing because we believe that patients should never have to worry if their medical bill will be paid as they are coping with an emergency situation," said Crane.

Balance billing occurs mostly as a result of unscheduled emergency room visits. Even though a hospital may be contracted with an insurance carrier for use of the facility, the ER physician or specialist performing the procedure may not have such a contract. Their price for the service is often much higher than what is reasonable and customarily paid to physicians under insurance contracts. In many cases, non-contracted physicians are charging more than double the customary rate. Faced with aggressive billing practices, including threats of being pursued by bill collectors, many patients feel pressured to pay whatever charges they are billed, despite the fact that they have insurance.

In October of this year, the California Department of Managed Health Care issued regulations that defined balance billing as an unfair billing practice. Immediately after the regulations took effect, the California Medical Association, hospitals, emergency room physicians and other medical specialists challenged the rules in court.

"Physician groups and their member doctors strongly opposed this legal challenge. As long-time opponents of balance billing, these regulations are right on target in addressing the problem and removing the patient as a pawn in disputes between medical providers," said Crane.

About CAPG

The California Association of Physician Groups (CAPG) is committed to improving health care for Californians. CAPG supports a progressive and organized system of health care delivery which focuses on coordinated treatment plans and comprehensive coverage, including the most current preventive services and exams. This allows physicians to focus on illness prevention and proactive management of patients in order to maintain their optimum level of health.

California Association of Physician Groups

• Additional
• References
• Citations