Thursday, July 27, 2006

ER doctors' fees targeted by governor

From the Sacramento Bee

Gov. Arnold Schwarzenegger on Tuesday acted to stop emergency-room doctors from charging patients for costs not covered by managed-care insurance plans.

In an executive order, the governor ordered the state agency that oversees managed health care to issue regulations barring the practice. He also directed the Department of Managed Health Care to set up a system for mediating payment disputes between insurers and doctors and determine fair prices for health services.

State officials said it was unclear whether the department would try to enact emergency regulations immediately or go through the normal regulatory process, which requires hearings and a public comment period.
"Gov. Schwarzenegger is firmly taking a position that no patient should be caught in the middle of a dispute between a doctor and an insurer," Cindy Ehnes, director of the DMHC, said Tuesday.

The practice, known as "balance billing," usually occurs when a patient enrolled in a managed-health care plan gets emergency care at a hospital that is not part of the health insurer's network. If the insurer pays less than the health-care provider is willing to accept, the provider charges the patient.


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