Hospitals protest new California rules on patient balance billing

We still live in a risk management world, one where the Department of Managed Care is shadowed by the power of the insurance companies; laws and regulations just seem to make everyone miserable these days. No matter how you look at it, all the problems these days come from one source, lack of payment from the insurers and it does not take a brain surgeon to figure it out. Insurance does not cover or pay the bills, and problems arise, consumers go without healthcare, go bankrupt, physicians have issues with payments, 50% of our hospitals are insolvent, again it all comes right back around to money.

Obviously this is a big break for the consumers and may save some bankruptcies, but on the other hand if the hospital borders on being insolvent and end up closing, then there’s no hospital left? If insurance paid the bills, you know I think this would go away, but it’s not that simple. It amazes me how the insurers find funds to invest and donate, and yet the core of their very business is the part that everyone hates, getting their healthcare paid for without battles. Yesterday Well point is donating 10 million for an X Prize winner to create a fix for healthcare, a great project, but what if it came down to a single pay system as the fix? Would that be able to happen in this case? How many claims could be paid with the the 10 million?

California passed a bill requiring that 85% of the premiums collected from carriers go towards medical care, so is there any winner here other than the insurance companies? BD

"The root cause of balance billing is HMOs underpaying providers," said Ned Wigglesworth, a spokesman for the California Medical Assn., which represents physicians.

Emergency room patients can no longer be stuck with the bill when hospitals or physicians disagree with insurance companies on their fees.
Under new state rules that take effect today, hospitals and physicians are barred from billing patients for the balance of emergency care not covered by insurers.

But the relief for patients may not last long. Hospitals and physicians are protesting the rules in court. Meanwhile, the state Supreme Court is set to hear another "balance billing" challenge next month.
And another court test may come sooner in a challenge by hospital chain Prime Healthcare Services Inc. of Victorville.

"No longer will Californians face the possibility that if they have to use an emergency room, they may be stuck with a bill, asking them to pay a second time for emergency care, which they already purchased with their [insurance] policy," she said.

Insurers accuse hospitals and physicians of taking advantage of the situation and sending out inflated bills. Hospitals and physicians counter that it is the insurers that take advantage by paying far less than reasonable and customary rates.