The California Department of Managed Health Care implements new regulations tomorrow to prevent “balanced billing,” good first steps to protect patients.
When insured patients find themselves going to an emergency room or ER doctor that is not contracted with their health plan, there is sometimes a dispute between the provider and the insurer about what the payment should be. The problem is that the patient is then sometimes used as a pawn in these billing disputes. The patient, who pays their premiums and is doing everything right, gets the bills for the disputed–or whole–amount, which also gets sent to collections and court.
So patients have their credit and their financial future ruined. The last few weeks have proved the essential importance of credit in today’s economy, and the practices of some providers have created a crisis for many California families.
As Lisa Girion at the Los Angeles Times reports, there is significant opposition from health care providers to these regulations. There’s a real need to resolve these provider-insurer disputes, fairly. Health Access California and other consumer groups supported SB921(Perata), a compromise measure to help resolve these differences, but the Governor vetoed it.
The regulations focus on the appropriate role of the agency, which is consumer protection: making balance billing an unfair billing practice, subject to civil penalties and “cease-and-desist” court actions. Nevertheless, these regulations are a good first step… but more work is needed.