Tuesday, July 18, 2000 | 9:39 a.m.
Some patients in managed care plans have discovered that they're getting unfairly billed for services that they shouldn't have to pay. In this instance, however, most often it isn't the health insurer that is at fault. Instead, these unnecessary bills -- referred to as "balance billing" -- come from the physicians who have contracts with the HMOs.
As is frequently the case with managed care, getting to the bottom of the issue can be difficult. But as the Sun's Steve Kanigher reported recently in an in-depth story on the controversy, the primary cause of "balance billing" is an ongoing dispute in which physicians contend the HMOs aren't reimbursing them in a timely way, sometimes taking months to do so. Doctors argue that they must send these bills to patients because the insurers aren't paying promptly. "Balance billing is a scare tactic to the patient to call the insurer," acknowledges Joe Kaufman, president of the Nevada chapter of the Medical Group Management Association.
This "scare tactic" is just plain wrong, however. The bottom line is that it is unfair to place the burden on the patient in what genuinely is a contract dispute over money between insurers and physicians. If a patient makes his co-payment at the time of the visit to the doctor, then it should be the physician's responsibility to take up any disagreement with the insurer. For their part, insurers should be more prompt in their payments to physicians, which would help stem the unnecessary double billing to patients. In fact, the 1999 Legislature passed a law that allows managed care plans only 30 days to either approve or deny an insurance claim; if the claim is approved, then the insurer has an extra 30 days to reimburse the medical provider.
Assemblyman Doug Bache, D-Las Vegas, who is running for re-election, says he will consider introducing legislation that would penalize medical providers who get carried away with balance billing. Obviously it would be preferable to have the insurers and physicians settle this spat themselves. But if they can't resolve this disagreement on their own, then the 2001 Legislature should step in and pass legislation that would give patients some protection from this needless billing.
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