Corrective Action and Balance Billing

Now that’s responsive.

After a nearly seven-hour hearing yesterday in which the Department of Managed Health Care’s consumer-protection creds were questioned, the Department has come out swinging (not that kind) on behalf of consumers.

The DMHC today released draft regulations on balance billing — that practice where consumers get a bill directly from the doctor or hospital for the difference of what is/was/will be paid by the insurance company, and what they charge. This is particularly pervasive in emergency situations where patients are unable to “shop around” and ensure that the provider they are being driven to is “in-network.”

The language to describe this practice is kind of edgy — as edgy as one can be in a “Notice of Rulemaking Action.” From the document:

“Innocent enrollees are routinely leveraged as bargaining chips in an unfair
provider billing pattern, which can lead to detrimental health care decisions by
the enrollee and aggressive collection activities by the provider, with
long-term harm to the enrollee’s health, safety, and financial stability.”

Right on. There’s more.

“..Providers use unfair and oppressive tactics, holding enrollees as virtual
financial hostages
, to pressure health plans to pay their full-billed charges,
irrespective of whether their full-billed charges do, in fact, reflect the
reasonable and customary value of the treatment provided.”

This is a fantastic opening position for advocates to be in on this issue. The comment period for these regulations ends May 12 at 5 p.m, so get letters in!

Health Access California promotes quality, affordable health care for all Californians.
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