03 August 2006

The Arnold sides against the Doctors

I just found out that last week, California Gov. Schwarzenegger issued an executive order directing the Department of Managed Care to issue regulations prohibiting the practice of "Balance Billing."

This is a disastrous development in the ritualized detante between physicians and health plans, especially for Emergency Room doctors. When we go to negotiate with health plans to determine how much they will pay us for services provided to their patients, the doctors are already disadvantaged. The HMOs set the terms, and the only leverage we have is to threaten to not sign the contract and go "non-par." When a patient is seen by a non-par physician, the HMO gets the bill, and pays whatever sum they like (or just denies it), and the patient then is responsible for the balance. It's an ugly thing: patients don't like it (and complain to their HMO) and hospital administration doesn't like it (and pressure the ED docs to sign). But it is the only leverage that the ED docs have to get the HMO to offer terms which will fairly compensate the doctors for their services.

Our group has gone non-par in the past, and it is an effective and useful strategy in our negotiations with the health insurers. If that tool is taken away from us by executive fiat (or legislative, as happened in Maryland), there is no ability for doctors to effectively negotiate to recieve fair compensation for their services.

And just for a sense of perspective, I paid more for a plumber to unclog my toilet the other day than I will get paid for taking care of a three-day-old with a fever last night. The CEO of Aetna made $35 Million in 2005, and the CEO of United Healthcare made $333 Million in 2005.


  1. This comment has been removed by a blog administrator.

  2. Billions are wasted on HMO executives each year.

  3. Several weeks ago (?months) you commented on Emergiblog re: BC/BS is no longer being considered good insurance. I am a federal employee and can chose from several insurers - including Mailhandlers, BC/BS, Aetna as well as the usual HMOs.
    Which of these provides better reimbursement for doctors? I have chronic illnesses and prefer to maximize access to good providers who will take my insurance (I live in Arnold's state). Thanks.


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