Members Needed to Testify at DMHC Hearing Next Week on Doctors’ Right to Fair Payment from HMOs
[Posted 10/18/07]

The Department of Managed Health Care has scheduled a public hearing on a new set of proposed regulations that would prevent noncontracted physicians from billing patients for emergency services. The hearing is next Wednesday, October 24, in Burbank.

CMA encourages all members to submit written comments and to testify in opposition to these onerous regulations. CMA believes these regulations attack the future viability of physician practices. They do not address the key underlying problems of unfair contracts, which result in inadequate physician networks, and chronic and pervasive underfunding of emergency care by insurance companies.

It is critical that DMHC hear from physicians, county medical societies, and specialty societies so that regulators understand the severe economic impact that these regulations will have on physicians and the health system in general.

In addition to prohibiting noncontracted and contracted physicians from billing enrollees for emergency services (except for copayments, coinsurance, and deductibles), the new proposal creates a voluntary independent dispute resolution process to resolve payment disputes; requires HMOs in the event of a payment dispute to pay physicians an interim amount of 150 percent of 2007 Medicare rates; and modifies the Gould criteria (the nationally accepted standard for determining fair and reasonable payment for health care services) to include Medicare and contract rates.

Physicians interested in testifying at the hearing should contact Francisco Silva at 916/551-2565 or fsilva@cmanet.org. If you are not able to attend the hearing, you can submit written comments on the proposed regulations until November 15.

Contact: Francisco Silva, 916/551-2565 or fsilva@cmanet.org.