Californias new regulations on balance billingor charging patients for services under dispute by providers and insurersin emergency-care settings go into effect Oct. 15, but they face a legal challenge from providers.
The rules forbid providers from balance billing patients for emergency medical services by making it an unfair billing practice, allowing the state Department of Managed Health Care to pursue enforcement actions against providers.
The California Medical Association and California Hospital Association, along with four other provider groups, have filed a lawsuit in Sacramento Superior Court challenging the state agencys authority to regulate balance billing and seeking an injunction to halt the rules. A hearing date has been set for Nov. 19.
California Gov. Arnold Schwarzenegger in 2006 issued an executive order to stop balance billing, leading to the regulations.
The physicians and hospitals deserve higher payments but it is inappropriate for them to use patients as leverage, said Cindy Ehnes, director of the DMHC, on a conference call with reporters.
The DMHC has launched a fair-claims payment initiative to boost enforcement of health plan violations such as low reimbursement, late payments and unfair billing practices and is setting up a special prosecution unit to speed up investigations and do special audits. The DMHC is suing Prime Healthcare Services, a Victorville, Calif.-based hospital chain, over balance billing. That case is pending. -- by Rebecca Vesely
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