Advocates Say Balance Billing of Medi-Cal Patients on the Rise

Advocates say that health care providers¬† increasingly are balance billing Medi-Cal beneficiaries — a practice that violates state law, the Los Angeles Times reports (Zamosky, Los Angeles Times, 9/18).
Balance billing refers to out-of-network providers charging patients for the difference between what patients’ insurers cover and what providers charge for the service (California Healthline, 2/18).

Details of Issue

Advocates say balance billing of Medi-Cal beneficiaries has been on the rise in the past year.
Stephanie Lee, the supervising attorney at the Neighborhood Legal Services of Los Angeles County’s health consumer center, said, “We get a significant number of people with Medi-Cal being impermissibly balance billed,” adding, “The services these patients get should be free, and then they get a nasty surprise.”
Lee said that the number of phone calls to her organization’s help line doubled in the last year, with many being complaints about balance billing among Medi-Cal beneficiaries.
Meanwhile, Georgia Burke, the directing attorney at Justice in Aging, said the issue stems from providers and patients misunderstanding the legal protections against balance billing.
For instance, Burke said that providers who accept Medicare patients but do not participate in Medi-Cal often ask for payment from patients who are dually eligible for the two programs. However, even if providers do not participate in Medi-Cal, they should bill the program for balances leftover after Medicare payments. Under the law, providers are required to “accept as payment in full” what the two programs pay for services, according to the Times.
Kata Kertesz, a policy attorney at the Center for Medicare Advocacy, said such misunderstandings could lead to patients paying bills they should not or forgoing care. “Frequently beneficiaries pay the bill out of their very limited income,” she said, adding, “Some may choose to forgo the care that they need because they are concerned that the bill will go to collections, which is too often the case, and they know that they are unable to pay.”
The state Department of Health Care Services said it is working on a notice to clarify the law for providers (Los Angeles Times, 9/18).