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 www.HL-ISY.com.

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 www.DecisionResourcesInc.com.

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   losgood@hl-isy.com                        emarshall@dresources.com 

First Call Analyst:
FCMN Contact:

SOURCE: HealthLeaders-InterStudy

CONTACT: Lisa Osgood of HealthLeaders-InterStudy, +1-781-296-2606,
losgood@hl-isy.com, or Elizabeth Marshall of Decision Resources, Inc.,
+1-781-296-2563, emarshall@dresources.com

Medicaid Reform Efforts Underway in Louisiana and Rhode Island

View Now