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Local physicians are in for a rough year thanks to new restrictions on billing patients, concludes a new study. According to the "Orange County Market Overview" compiled by HealthLeaders-InterStudy, which provides market intelligence for the managed-care industry, California Department of Managed Health Care regulations now prohibit an out-of-network physician from billing a health plan member for charges not covered by insurance, a practice called "balance billing." The state agency began implementation of the regulations last October, but it was challenged in a lawsuit filed by physician organizations. The suit was rejected in December and is likely to be appealed.
The new regs will be particularly burdensome for emergency room physicians, who often see uninsured or under-insured patients, says Josh Kelley, HealthLeaders-InterStudy market overview analyst. "In locations where emergency room access is already a challenge," he said, "this ruling will make it worse as hospitals continue to struggle with reimbursement issues."