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Balance Billing Ban Upheld, but Who’s Going to Enforce the Policy?

Posted Dec 06 2008 8:39am

Doctors and hospitals can’t balance bill, but the Department of Managed Care doesn’t have the authority yet to enforce?  This brings about a very good question of who will enforce this.   Is this a provision with no teeth?  Obviously this is good for patients as you come out with a bill of so many unknowns being added to the tab at times, but on the other hand, when items that are not anticipated enter the picture and are added, who will pick up the tab, or if one is seen by a physician out of network and potential higher charges apply.

Prime Healthcare in California has been in the spotlight here and is probably responsible for bringing this entire issue to the forefront.  Without anyone at the helm enforcing the ban, is it business as usual?  Last I looked, patients are still receiving bills for the balances and the battle is still alive and well, so it would be nice to have an entire cohesion here and have laws with some teeth that set the rules of the game up front. The situation is still not complete as the CMA and other parties have 60 days to file an appeal, so in the meantime one big lot of gray remains.  BD 

A Sacramento Superior Court judge issued a ruling Wednesday upholding state regulations that prevent doctors and hospitals from billing patients when their health plan doesn’t pay enough to cover their bills, state regulatory officials announced.

Drafted by the state Department of Managed Health Care, the regulations define balanced billing as an unfair billing practice prohibited by state law. The rules took effect Oct. 15.

The court explicitly chose not to address whether the DMHC has the authority to enforce that definition against providers, leaving that issue for another day.”“The California Association of Health plans is pleased to see the courts agree that consumers need to be protected from the predatory practice of balanced billing. Insured patients who are playing by the rules should not be used as leverage in billing disputes between health care providers and insurers,” Chris Ohman, chief executive officer at the California Association of Health Plans, said in a prepared statement.

http://www.bizjournals.com/sanfrancisco/stories/2008/12/01/daily72.html

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