From my colleague Elizabeth Abbott:
“Balance billing” is the term for the practice of health care providers, who when in a billing dispute with an insurer, send the bill to the patient and place them in the middle of that dispute.
It’s something that health care consumers have long complained about. The state Department of Managed Health Care (DMHC) is trying to find a way to fairly and quickly decide those billing disputes without allowing these powerful combatants to stick the patient with the bill. These disputed bills often represent hundreds and even thousands of dollars that patients can often ill-afford to pay. Consumers often feel responsible for those bills and pay them to the detriment of housing, utilities, transportation or other expenses. Some consumers ignore these bills and risk being referred for formal debt collection and recovery which remains a leading cause of personal bankruptcy.
We need to stop this practice. The question is how.
DMHC held a public hearing on Wednesday in Burbank on their proposed new rule that would
* ban consumers from being balanced billed for any amounts in dispute,
* establish a formula for an interim payment amount for the doctor who provided the emergency services, and
* institute an equitable system to decide on a fair final payment amount owed by the health plan for services rendered.
Doctors argued strenuously that they were at a disadvantage against the powerful health care plans with multi-million dollar profits. They felt they were forced to send the disputed bills to their patients because they needed the leverage of the consumer to intercede on their behalf with health plans. Many physicians who gave testimony cited the loss of hospitals and trauma centers throughout California due to too few doctors and inadequate reimbursement. This further eroded the state’s ability to provide health care to its residents.
Health plans said they had great difficulty signing up enough physicians, particularly specialists to staff emergency rooms, often in small towns and rural areas. They felt doctors were taking advantage of the system to extract large fees from health plans. They said as a result that physicians were reluctant to contract with health plans for reasonable rates to provide these ongoing services.
There was lengthy testimony from both sides. In addition, consumer advocates argued that under no circumstances should patients be put in the middle between doctors and health plans over these disputed bills.
DMHC announced it would hold two more public hearings on the issue in November (possibly one in San Diego and one in Sacramento), and would extend the date for public comment until the end of the month before issuing the final version of the regulation.