Article - May 14, 2008 - OCRegister
Hearing held on billing practices for insured patients
The state hears testimony from patients who have been billed for costs their insurer won't pay
By Courtney Perkes
IRVINE Dozens of patients and doctors complained today to state health regulators about hospital billing disputes.
The state Department of Managed Health Care held its eighth public meeting, this one in Orange County, on the topic of "balance billing." The practice occurs when a hospital or doctor who is not contracted with an HMO bills a patient for whatever the health plan doesn't pay. State regulators want to outlaw the practice, saying patients should not be stuck in the middle of financial disputes between their insurance companies and their medical providers.
The issue came to a head this month when the owner of three Orange County hospitals sent out bills to 7,000 members of Kaiser Permanente. The massive billing effort is part of an ongoing legal dispute with Kaiser over its rate of reimbursement. Kaiser has told its health plan members not to pay. State officials also say that consumers are not responsible for bills that are part of their insurance coverage.
Carolyn Moore, a Kaiser member, told regulators she won't pay a $4,000 bill from Prime Healthcare Services, owner of West Anaheim Medical Center, Huntington Beach Hospital and La Palma Intercommunity.
"I believe the hospital owner is trying to blackmail us," said Moore of Yorba Linda. "It's not my responsibility."
By law, health plans are required to pay "reasonable" rates to doctors and hospitals they don't have contracts with. But they disagree over how to define reasonable.
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