Navigation Links
Regulations Against Balance Billing to Impact Orange County, Calif., Physicians' Bottom Line

Enforcement Impacts Emergency Room Physicians in Particular, According to New Report from HealthLeaders-InterStudy

NASHVILLE, Tenn., Feb. 23 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that physicians in Orange County, Calif., face a number of challenges in the coming year, including new restrictions on billing patients. According to the new Orange County Market Overview, regulations issued by the California Department of Managed Health Care prohibit an out-of-network physician from billing a health plan member for charges not covered by insurance, a practice commonly referred to as balance billing.

"The regulations against balance billing are a challenge for all physicians operating in Orange County, Calif., but will be particularly challenging for emergency room physicians who often see uninsured or under-insured patients," said Josh Kelley, market overview analyst with HealthLeaders-InterStudy. "In locations where emergency room access is already a challenge, this ruling will make it worse as hospitals continue to struggle with reimbursement issues."

The agency began implementation of the regulations in October 2008, and was challenged in a lawsuit filed by physician organizations. While the lawsuit was rejected in December 2008, it is likely to be appealed.

"Balance billing will continue to be an issue to watch in markets across the state, particularly as the California health plan market is known for strong HMO networks, giving physicians little leverage," said Kelley. "However, challenges around balance billing are not confined to California. For instance, our recent Indianapolis Market Overview finds that balance billing will be up for discussion in the 2009 legislative session as Indiana lawmakers will be debating a bill that seeks to limit dual billing by providers when patients receive emergency treatment from out-of-network physicians."

Why Pharmaceutical Companies Need Market Overviews

Market Overviews provide a detailed analysis of local healthcare market drivers in 87 of the nation's most dynamic metro areas, allowing pharmaceutical executives to quickly gain local area expertise. Each report provides local-level insights into: health systems and hospitals, physicians, health plans, Medicare/Medicaid, pharmaceutical environment, legislation and employers.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

    For more information, contact:

    Lisa Osgood                               Elizabeth Marshall
    HealthLeaders-InterStudy                  Decision Resources, Inc.
    781-296-2606                              781-296-2563              

SOURCE HealthLeaders-InterStudy
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. Just Completed Studies Reveal Impact of New Medicare Reimbursement Regulations
2. APHA Says New Ozone Regulations a Missed Opportunity to Protect Publics Health
3. Food Policy Institute primer on food imports and regulations
4. Golden State Medical Supply Selects IBM Technology to Comply With California Prescription Drug Pedigree Regulations
5. APIC Conference to address new CMS regulations
6. APIC Conference to Address New CMS Regulations
7. AHIP Statement on CMS Proposed Medicare Marketing Regulations
8. New Regulations for Hospice Provision Published by CMS
9. Statement by Christine James-Brown, President and CEO, Child Welfare League of America (CWLA) Re: Moratorium on Medicaid Regulations
10. Proposed Medicare Regulations Threaten to End Millions of Free Meals Offered to Seniors During Education Seminars
11. Public Interest Groups Back Federal Court Appeal to Implement New U.S. Patent Rules; Proposed Regulations Would Curtail Abusive Behavior by Patent Applicants
Post Your Comments:
(Date:11/27/2015)... ... November 27, 2015 , ... An inventor, ... to dispense prescription medications at home, so he invented the patent-pending ELECTRONIC M.D. ... dispense prescription medications. In doing so, it could help to prevent potential overdose ...
(Date:11/27/2015)... Aliso Viejo, CA (PRWEB) , ... November 27, 2015 , ... ... exclusively for use in Final Cut Pro X. With ProSidebar: Fasion, video editors ... banners, or use ProSidebar as a minimalist title opener. Utilize presets featuring self-animating ...
(Date:11/27/2015)... ... November 27, 2015 , ... A simply groundbreaking television series, "Voices ... show that delves into an array of issues that are presently affecting Americans. Dedicated ... open dialogue, this show is changing the subjects consumers focus on, one episode at ...
(Date:11/27/2015)... , ... November 27, 2015 , ... ... largest, most successful and prominent nonprofit healthcare organizations in the country. They have ... with various organizations, and helped advance the healthcare industry as a whole through ...
(Date:11/26/2015)... ... 26, 2015 , ... Patients at Serenity Point Recovery, a ... on Thanksgiving Day to share the things that they are most grateful for ... YouTube channel, patients displayed what they wrote on index cards, describing the things ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 26, 2015 3D bioprinting market ... to a new report by Grand View Research Inc. Rising ... which demands kidney transplantation is expected to boost the market ... for organ transplantation. --> 3D bioprinting market ... to a new report by Grand View Research Inc. Rising ...
(Date:11/26/2015)... , November 26, 2015 ... of the "2016 Future Horizons and ... Abuse Testing Market: Supplier Shares, Country Segment ... to their offering. --> ... "2016 Future Horizons and Growth Strategies ...
(Date:11/26/2015)... , November 26, 2015 ... --> adds "Global Repaglinide ... "Investigation Report on China Repaglinide Market, ... forecasts data and information to its ... . --> ...
Breaking Medicine Technology: