Would you be surprised to receive an exorbitant, unexpected medical bill for a hospital visit when you had medical insurance? Of course you would, and yet that is exactly what happened to Martha Berryman, who had chest pains and was taken to the nearest hospital.
But because the hospital was not under contract with her health plan, she received a bill for more than $12,000. She also started getting collection notices and was terrified that she would lose her health coverage, which she needed for herself and her quadriplegic daughter.
Unfortunately, Martha and many more Californians like her have been victims of a little-known financial war at the state Capitol and in the health care provider community, which allows patients to be put in the middle of billing disputes between health plans and providers, such as doctors and hospitals.
"Balance billing" makes patients, not providers or health plans, responsible for paying the disputed difference between their provider's bill and what the health plan decides to pay.
However, this frightening reality may soon be history because of new regulations sponsored by the Schwarzenegger administration's Department of Managed Health Care. The regulations restrict balance billing for emergency services rendered by non-contracted providers.
Consumers, employers and taxpayers pay billions of dollars each year in health care premiums in exchange for a promise to protect them from unexpected bills when a health emergency strikes. That's why we must also aggressively address the root cause of balance billing, which is unfair claims payment practices by health care plans and which leads providers to drop their contracts.
The Department of Managed Health Care has been working for the past several years to solve this long-standing issue of claims payment disputes that have permeated the health care industry. Some say that by eliminating the ability of doctors to turn to patients to make up the difference between what they think they are owed and what they are paid by a health care plan, we are jeopardizing the financial stability of the emergency care system. Nothing could be further from the truth. We have long advocated that emergency room and all other providers should be paid fairly. But we're going forward with our regulations to protect consumers because, until the two sides can come to a compromise, patients should not be picking up the tab.
Cindy Ehnes, director of the California Department of Managed Health Care, is responding to William K. Mallon's Aug. 21 My View column, "There's nothing balanced about 'balance bills.' "
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