Maryland lawmakers want to banish ‘balance billing’ by some doctors
Published: 2010-07-10 21:57:00By: Scott Graham | Baltimore Business Journal | March 19, 2010
A bill designed to take patients out of the health care billing equation could end up taking money away from physicians who work for hospitals if two leading members of the House of Delegates get their way.
In exchange for their support of legislation that would allow patients to direct their health insurer to send fees to out-of-network physicians, Delegates Peter A. Hammen and Shane E. Pendergrass favor a prohibition on balance billing by doctors employed by hospitals. Balance billing is the legal practice in which an out-of-network physician bills a patient for the balance of a charge for health care services not covered by the insurer.
And while balance billing is not presently abused by hospital-employed physicians like radiologists, pathologists and anesthesiologists, Hammen and Pendergrass — chair and co-chair, respectively, of the House Health and Government Operations Committee — say passing the so-called assignment of benefits bill in its current form could create such a problem. If a physician is not satisfied with the insurer’s payment for care, he or she could decide to bill patients for hundreds or thousands of dollars more, Hammen and Pendergrass said.
“I don’t want to create a situation where I hear from my constituents who are being balance billed by doctors they never met,” said Pendergrass, a Howard Democrat who chairs the House Health and Government Operations Committee’s insurance subcommittee. “I’d like more comfort in knowing that doctors aren’t going to gouge patients.”
Pendergrass will tackle balance billing March 23, when her subcommittee begins its work on House Bill 147. The bill, which was passed by the Senate on March 15, is expected to be among the most contentious pieces of legislation the subcommittee tackles this year. It’s also the latest battle in a perennial turf war over health care costs between insurers and health care providers.
“There’s going to be a lot of heavy lifting going on over here,” said Del. Shawn Tarrant, a Baltimore Democrat and member of the insurance subcommittee. “It’s going to be tough to call this one.”
Defeating the bill is a top legislative priority of the region’s largest health insurer, CareFirst BlueCross BlueShield, which says allowing patients to assign benefits could drive some physicians out of its network and ultimately drive up health care costs for individuals and employers. If patients are allowed to assign benefits, physicians could leave the insurer’s network and then bill for a higher, non-negotiated rate.