Balance Billing Legislation is Spreading from California

California’s high court ruled that emergency-room patients can no longer be billed by doctors and hospitals for care that isn’t fully paid by their health plans. Texas and Louisiana have similar legilation pending but with more sweeping coverage for pathologists, anesthesiologist, radiologists and emengency medicine providers.

Balance billing tends to be defined in the debate as the practice of out-of-network physicians billing a patient for the difference, or “balance”, between what the health plan pays for out-of-network services and the physician’s fee. Legislative proposals to eliminate balance billing tend to cast the practice in the same light as insurance fraud, with attendant civil fines and licensing sanctions. Physician-friendly legislation that addresses the subject would require payors to fully reimburse providers for most out-of-network services, regardless of the charges.

Anesthesiologist, Radiologists, Pathologist and Emenecency Medicine physicans will be severely impacted by his new legislation. It will mean that the leverage that they once had to negotiate higher rates with insurance payers has been eliminated.  This is just one more parameter forcing these physicians to require more financial subsidies from the hospital to maintain their present income levels.

Immediate Implications from this loss in income stemming from the ruling could exacerbate challenges at hospital EDs and discourage medical specialists from accepting emergency cases. This could also cause a movement of physicians into states that do not have  restrictions on their ability to earn a market competitive wage.