California Court Upholds Rules Prohibiting Balance Billing

[CAL/AAEM News Service]

California
Court Upholds Rules Prohibiting Balance Billing

 

Source: The California Healthline (http://www.californiahealthline.org)

Date: December 04, 2008

 




On Wednesday, a Sacramento Superior Court judge ruled that
the Department of Managed Health Care has the authority to bar doctors from
participating in balance billing, upholding a disputed regulation prohibiting
the practice that took effect in October, the Los Angeles Daily Journal reports
(George, Los Angeles Daily Journal, 12/4).

 

Oftentimes, balance billing occurs when insured people are
treated in hospital emergency departments by doctors who are not included in
the patients' health plans' preferred networks. 

 

Insurers reimburse doctors and hospitals at a lower, out-of-network
rate, and the health care providers bill patients for the remainder of the
charges (Calvan, Sacramento Bee, 12/4).

 

The California Medical Association, the California
chapter of the American
 College of Emergency
Physicians and other groups filed the lawsuit (California Healthline, 10/14).

 

Ruling Details

 

In his ruling, Sacramento County Superior Court Judge
Michael P. Kenny denied a request for injunctive relief and dismissed arguments
by doctors groups that DMHC had exceeded its authority.

 

Kenny did not take a stance on whether the new rule would
unjustly benefit health plans or hurt health care providers. 

 

Reaction


In a prepared statement, DMHC Director Cindy Ehnes said, "Our
legal authority to protect consumers from bills they should never have received
has now been confirmed."

 

Francisco Silva, general counsel for the California Medical
Association, said the ruling will undermine the state's emergency medical
system because it will leave doctors with unpaid bills and minimal recourse..

 

Silva said his group will likely appeal Wednesday's decision.

 

Supreme Court Ruling Expected

 

The ruling could be superseded by the California Supreme
Court, which heard a similar case centered on balance billing last month.   

 

According to the Daily Journal, a ruling in that case is expected
"within weeks" (Los Angeles Daily Journal, 12/4).

 

Broadcast Coverage

 

On Wednesday, Capital Public Radio's "KXJZ News" reported
on the ruling (Weiss, "KXJZ News," Capital Public Radio, 12/3).

 

Other States

 

Outside of California, balance
billing has sparked regulatory action in Illinois
and New York,
the Wall Street Journal reports.

 

The Journal profiles several cases of balance billing and
provides tips for patients to avoid being balance billed (Wilde Matthews, Wall
Street Journal, 12/4).

 

For more information, please visit:

http://www.californiahealthline.org/Articles/2008/12/4/California-Court-Upholds-Rules-Prohibiting-Balance-Billing.aspx





Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/

CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.  


      
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