DMHC Proposal Would Prevent Physicians from Billing for Services Rendered
[Posted 08/17/06]

The Department of Managed Health Care (DMHC) this week proposed new regulations that would inhibit physicians’ ability to bill for services rendered, potentially devastating the delivery of emergency care in California. While CMA understands that patients do not want or expect to be billed because their insurance companies don’t pay reasonable physician charges, these regulations attack the future viability of physician practices, while doing nothing to solve the real underlying issue of for-profit HMOs refusing to pay fairly for emergency care.

The proposed regulations were filed in response to an executive order issued last month by Gov. Arnold Schwarzenegger, which directed DMHC to stop physicians from billing patients for emergency care.

DMHC had last week filed emergency regulations, which would have gone into effect within 10 days. Thanks to strong and immediate CMA advocacy, the emergency regulations were withdrawn. However, DMHC decided to pursue the matter through the formal permanent regulation process, which involves public comment and review. That process includes a minimum 45-day comment period and physicians will be encouraged, at the appropriate time, to provide professional comment on the potentially devastating impact these regulations would have on the emergency care system.

CMA believes that a unified and strong physician message must be delivered to the Governor. The Administration should abandon any plans for regulating physicians ability to bill for services rendered. The proposed regulations are a direct attack on physicians and their ability to pursue payment for lifesaving care.

The Governor can be reached by phone (916/445-2841), fax (916/445-4633), or e-mail (http://www.govmail.ca.gov).

CMA’s policy on this issue is to oppose any proposed ban on so-called “balance billing,” while advocating for insurance reforms to protect fair funding for emergency care. CMA has developed a legislative package that would help stabilize California’s emergency care system by ensuring that HMOs contract with sufficient numbers of physicians to provide care for all their insured, and requiring that they spend at least 85 cents of every premium dollar on health care.

Click here to read the proposed regulations.

Contact: Susan Bassett, 916/444-5532 or sbassett@cmanet.org.