Physicians Tell DMHC that Health Plans Must Fairly Pay Noncontracted Physicians
[Posted 09/21/06]

Dozens of physicians from CMA and the California Chapter of the American College of Emergency Physicians (Cal/ACEP) last week descended upon a Department of Managed Health Care (DMHC) hearing in Burbank, demanding that DMHC drop proposed regulations that would stop physicians from billing for services rendered.

The regulations were filed in response to an executive order issued by Governor Schwarzenegger earlier this summer that directed DMHC to stop physicians from billing for emergency care.

Jim Hindsdale, M.D., vice chair of CMA’s Board of Trustees, and Brennan Cassidy, M.D., board chair, ably represented CMA at the hearing, imploring the committee to drop the proposed regulations and engage DMHC to “do its job” as health plan regulator by requiring plans to contract with adequate physician networks and stopping the chronic underfunding of emergency care by insurance companies.

Dozens of physicians delivered personal stories of hours spent providing lifesaving care in the emergency room, only to receive pennies-on-the-dollar reimbursement from insurance companies. Steven Kim, M.D., assistant medical director of the Department of Emergency Medicine at Inland Valley Medical Center in Widomar, told the committee about a patient who came into the ER with a serious hand injury. “I had a patient who came in the other day who sliced his hand, three or four fingers and down the palm with some tendon injuries,” said Dr. Kim. “It took me about an hour to fix it. And I was just wondering if the committee had any thought on what you think a fair reimbursement for that would be.” Dr. Kim told the committee that he billed $180 for saving the patient’s hand and the health plan paid just $40.

Testifying physicians delivered a strong and consistent message: Physicians don’t want to bill patients and DMHC should ensure that insurance companies—whose profits continue to soar—pay fair and legitimate ER bills.

DMHC will hold two more hearings on these regulations, Monday, September 25, in San Diego, and Wednesday, October 4, in Sacramento. Physicians interested in testifying at either hearing should contact Susan Bassett at 916/444-5532 or sbassett@cmanet.org.

The regulations are also open for written public comment until October 4. It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that state officials understand the severe economic impact these regulations will have on physicians and the health system in general. Comments may be sent either to DMHC directly or to CMA for inclusion in the association’s formal comments.

CMA has posted on its website templates that organizations and individual physicians or physician groups can utilize when preparing their comments. Please keep in mind that these templates are only models, and you should tailor your comments to reflect your particular circumstances and explain in your own words how these regulations will affect your practice. Even if you submit your comments to DMHC directly, please also send a copy to CMA by e-mail (legalinfo@cmanet.org) or fax (415/882-5143).

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