IRVINE—CALPIRG Health Care Advocate Michael Russo testified today at a
Department of Managed Care hearing in Irvine, calling for the enactment
of new regulations to protect patients from balance billing.
When
patients are taken to the hospital for emergency treatment, they may be
treated by doctors who are not part of their insurance plan’s network. When this happens, some hospitals send a surprise bill directly to the
patient. Usually the exorbitant bills are not meant to be paid, but
rather help the doctors get a higher rate out of insurers when they
negotiate over rates, as patients put pressure on their insurance
company to pay the bill.
“Consumers
– patients – are being used as bargaining chips in negotiations between
health plans and hospitals,” said Russo. “The legal obligation to pay
for these services rests on the health plan, not the patient. And yet
day after day, insured Californians get surprised with these gotcha
bills.” The Department of
Managed Health Care is currently considering regulations that would bar
providers for balance billing patients for emergency services. Russo
urged the department to enact the regulations. “Almost 2 million
Californians were surprised by balance bills last year,” he said. “Working families already have a hard time paying for health care – the
last thing they need is to be stuck paying bills they should never have
gotten.”
Some
provider groups oppose the regulations because they say insurers will
not pay them a fair rate unless they are able to use patients as
leverage. “Insurers need to play by the rules too,” said Russo, “but
that’s no reason to keep patients trapped in the crossfire between the
providers and the plans.”
