'Balance Billing' Lawsuits Emerge After California Supreme Court Ruling

[CAL/AAEM News Service]

'Balance Billing' Lawsuits Emerge After California Supreme
Court Ruling

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

Date:  February 11,
2009

 

A January California Supreme Court ruling banning so-called
"balance billing" has raised the prospect of hospitals and emergency
department physicians facing lawsuits from patients seeking refunds for cases
in which providers billed patients for charges their health plans did not pay,
the Los Angeles Daily Journal reports (George, Los Angeles Daily Journal,
2/11).

Balance billing typically occurs when insured people seek
emergency care at facilities that are not included in their HMOs' preferred
provider 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 (California
Healthline, 1/9).

At least two lawsuits have been filed seeking retroactive
reimbursements from health care providers, sparking concerns from providers
that they could face hundreds of millions of dollars in refunds to patients..

According to the Journal, a central issue in the suits is
whether the ruling deeming balance billing illegal applies retroactively.

The Department of Managed Health Care contends that
regulations banning balance billing took effect on Oct. 15, but the Journal
reports that the state Supreme Court ruling was less clear about when the
prohibition on balance billing took effect.

Comments

Elena Lopez-Gusman, director of governmental affairs for the
California chapter of the American College of Emergency Physicians, said,
"Balance billing was legal." She added, "To say that (the law)
was retroactive is requiring physicians to have had a crystal ball four years
ago."

Francisco Silva, general counsel for the California Medical
Association, said ED physicians could file cross complaints against health
plans for the low rates they pay (Los Angeles Daily Journal, 2/11).

For more information, please visit:

 http://www.californiahealthline.org/Articles/2009/2/11/Balance-Billing-Lawsuits-Emerge-After-California-Supreme-Court-Ruling.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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