Bay Area physicians are warning that emergency room closures and staffing shortages could follow if a proposal by Gov. Arnold Schwarzenegger to prevent doctors from billing patients for uninsured expenses is foisted on them.
Promoted by the governor as a measure to protect California patients from expensive medical costs, the order would prevent doctors from billing patients directly when their insurance company denies a claim. Such situations are common when a patient receives emergency care from a doctor who isn’t within their insurance network, said Dr. Gordon Fung, president of the San Francisco Medical Society.
"If this is allowed to go forward, emergency departments — which are already losing money — will continue to close, resulting in less access for patients," Fung said. Since 2000, about 60 emergency rooms in the state have closed, leaving about 300, according to Peter Warren, spokesman for the California Medical Association.
But major health insurers are standing behind the governor’s proposal, arguing they want to protect their members from doctors and debt collectors. "There is a negative impact on our insurance members when physicians go after patients for unbalanced bills," Blue Cross spokesmanRobert Alaniz said. In some cases physicians have been known to put liens on homes, Alaniz said.
Insurance companies are trying to cast the issue as rich doctors going after poor patients, when it is the multimillion-dollar health insurance industry that refuses to expand their physician networks for their members, Warren said.
Physician shortages might result from the governor’s proposal, said Dr. David Goldschmid, San Mateo County Medical Association president. In particular, specialists in fields such as plastic surgery, urology and neurosurgery — who serve as voluntary on-call physicians and aren’t paid by the hospitals they work for — are likely to reduce their availability, Goldschmid said.
"They make their money through patient fees," Goldschmid said. "[The governor’s] decree essentially states that they must accept whatever they are offered by the insurance companies," which is sometimes less than 50 percent of the costs.
With the state’s powerful medical unions and the insurance industry now firmly entrenched, the issue has become a political hot potato. Some private hospitals in The City and San Mateo County that could be affected — California Pacific, Ralph K. Davies, Saint Francis Memorial, Mills-Peninsula, Sequoia and Seton, among them — declined to comment, saying the issue had become too political.
In fact, Gov. Schwarzenegger, who actually implemented the new regulations as an executive order at the end of July, rescinded them two weeks later after the California Medical Association called them "wrongheaded." Public hearings are now set on the matter for Sept. 13 in Burbank and Oct. 4 in Sacramento.