Lawmakers, consumer advocates and healthcare professionals are part of an ongoing discussion in California on how to curb balance billing, according to a California Healthline report.
The practice of balance billing refers to an out-of-network physician's ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, have the ability to bill patients for the entire remaining balance.
Balance billing may occur when a patient receives a bill for an episode of care previously believed to be in-network and therefore covered by the insurance company, or when an insurance company contributes less money for a medical service than a patient expected.
Here are three things to know about the balance billing discussion in California.
1. Consumer advocates are slated to launch a campaign March 21 in hopes of eliminating balance billing.
2. Under legislation recently reintroduced by California Assemblyman Rob Bonta (D-Oakland), consumers who go to an in-network facility but are treated by an out-of-network provider there would only be charged what they would have been charged if the provider participated in their plan, according to The Wall Street Journal. Physicians who thought they were underpaid would have the option of appeal.
3. The California Medical Association has come out in opposition to Assemblyman Bonta's bill, and is working on a plan of its own with a different approach to the problem, according to the report. Overall, the association wants a plan that puts more of the financial onus on insurers and provides physicians with a better deal, the report states.
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