DMHC Proposes New Balance Billing Rules
[Posted 04/14/08]

The Department of Managed Health Care (DMHC) recently withdrew its previously proposed balance billing regulations and proposed new regulations, the fourth such proposal in three years. 
     
The new regulation defines “unfair billing patterns” to include the practice of balance billing patients when their HMOs fail to pay fairly for emergency services provided to their enrollees. In other words, balance billing by hospitals and hospital-based physicians – including on-call specialists – would be considered unfair and therefore illegal billing practice. The proposal neither provides for interim payment in the event of a billing dispute, nor does it mention a dispute resolution process.

CMA is preparing written comments in response to the proposal, which continues to favor health insurers at the expense of physicians, patients, and the future health of emergency services in California. CMA also plans to seek a public hearing to provide doctors an opportunity to express their views about the proposed regulation.

Click here to read the text of the proposed regulations.

Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.