CAHP Statement: Consumer Win Against Balance Billing
May 24, 2010
Contact: Nicole Kasabian Evans
Statement from California Association of Health Plans President Patrick Johnston - May 24, 2010
State Regulator Secures Hospital Settlement on Balance Billing Practices
SACRAMENTO -- The California Association of Health Plans (CAHP) President Patrick Johnston issued the following statement after the Department of Managed Health Care announced reached a settlement with Prime Healthcare in People vs. Prime Healthcare Services (Prime), which accused the hospital system of balance billing patients.
"Today's settlement is another victory for consumers in the fight against balance billing," said CAHP President Patrick Johnston. "It also demonstrates that the California Supreme Court's 2009 prohibition on balance billing is having the intended result - patients cannot be put in the middle of billing disputes between physicians and health plans."
"California's health plans have long fought against the predatory practice of balance billing patients because it is just plain unfair for patients. Not only do these unexpected bills cause families undue anxiety and stress, but in 2006 and 2007 it placed a $528 million burden on California's insured patients.
"In the past, balance billing added hundreds of millions of dollars in excess costs at a time when health care costs are already growing 2-to-3 times faster than economy. We need to be working on lowering health care costs."
Background:
Balance Billing is the practice where an uncontracted medical provider unfairly places a financial burden on the patient by billing them for all charges not paid for by the patient's insurance plan, even if those charges are above the plan's usual and customary rate or are considered medically unnecessary. According to a 2007 study commissioned by CAHP, more than 1.76 million insured Californians who visited Emergency Rooms in the last two years received balance bills on top of their co-pays and deductibles.
The average bill was $300, meaning Balance Billing is a $528 million burden on insured patients.
In January 2009 the California Supreme Court unanimously ruled that emergency room doctors were expressly prohibited from directly billing patients if they want a payment that is higher than what the health plan pays. CAHP filed an amicus curiae ("friend of the court" brief) in support of the plaintiffs in the case, Prospect Medical Group vs. Northridge Medical Center.
The California Association of Health Plans is a statewide trade association representing 39 health plans that provide health coverage to more than 21 million Californians. The Association's mission is to improve the health of California's communities by promoting the growth of health plans dedicated to providing high-quality, affordable, accessible health care to their members.
For more information about CAHP please visit www.calhealthplans.org.
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For media inquiries, please contact Nicole Kasabian Evans, our Vice President of Communications, via e-mail (nevans@calhealthplans.org) or at 916.552.2914.
