California Regulators Begin Hearings on Draft Regulations That Would Ban ‘Balance Billing’

The California Department of Managed Health Care last week began a series of public hearings on draft regulations that would bar physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay, the Los Angeles Times reports. Gov. Arnold Schwarzenegger (R) in 2006 ordered state regulators to ban the practice, but DMHC has not been able to reach a compromise. The agency this spring proposed outlawing the practice and drafted the regulations.

Health care providers who use the practice say insurers are not reimbursing them enough for services. Many of the bills involve people who seek treatment or are taken by ambulances to emergency departments at hospitals outside their insurer's network.

A 2006 survey by the California Association of Health Plans found that more than 1.75 million California residents who visited EDs in the last two years received $578 million in medical bills not covered by their insurers in addition to their copayments and deductibles. About 60% of the patients paid the bills, according to the survey (Costello, Los Angeles Times, 5/17).