Orange County Doctors Face Challenges as Billing Practice Ends

Orange County Doctors Face Challenges as Billing Practice Ends

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 e
mergency 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."


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