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| "Balance Billing" ruling |
This is in reference to the recent ruling by the Department of Managed Health Care in California. To understand what the ruling is, let’s see what “Balance Billing” is all about.
Whenever a doctor provides a service, he/she can set the fee for that service. It does not mean that they are going to get paid the fee that they charge. There are many doctors who practice at different hospitals. They may not be hospital employees. The hospital may have a different contract with the HMO and a different contract with the doctors. In most cases, the HMO payment is less than what the doctor bills and sometimes less than the UCR (Usual, Customary and Reasonable charges). If the doctor does not have a contracted amount for the provision of that service, he/she can bill the patient for that portion not covered by insurance.
The ruling would prohibit hospitals and hospital-based physicians from billing patients for the cost of emergency department services that should be covered under patients' health plans. Looking at this from a patient’s perspective, the ruling is welcome. From a doctor’s perspective, this is not good and might prevent them from contracting with HMOs. |
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| Posted by: anandgad
on 4/4/2008 8:15 AM
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Comments (27)
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