Out of Network Balance Billing

[old_boy]

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I realize this news is now almost a year old, but I just stumbled across this and am curious on the effect of California's ban on out of network balance billing? Here's the California article:
http://www.ama-assn.org/amednews/2009/01/26/prsa0126.htm
Do any of you in California have experience with how this has effected things? (spyderdoc, roja, looking in your direction)

My guess is that insurance companies in other states are salivating at the thought of similar legislation nationwide. With this law, insurance companies have no incentive to contract with ANY hospitals/groups for emergency services and are essentially free to pay whatever they choose. A government "public option" linked to medicare rates seems attractive by comparison.

 

[docB]

The balance billing has really hurt EPs and call panel docs in CA. My group in in the division of our corporate overlord that includes CA so I get the numbers. What we've seen so far looks like a hit of ~10%.

You are correct that it creates a situation where there is no incentive for any insurer to negotiate with any medical group because they can just establish some low ball rate and then pay you that.

This was all done in the name of keeping the patient "out of the middle" of the billing issues about the care that they receive. I can't figure out who should be in the middle more than the patient when it comes to paying for their care but I'm just an automaton mandated by EMTALA to provide free care so what do I know.

Here is a thread that popped up in the Topics in Healthcare forum last January. You can see how there is a lot of ignorance about what balance billing is, why it happens and what the ramifications of outlawing it are.