By Ron Shinkman, Editor, Laboratory Industry Report
A San Diego-area pathology practice was recently cited by California regulators for years of billing hospital emergency room patients for sums they were not legally obligated to pay.
North Coast Pathology Medical Group came to an agreement last month with the California Department of Managed Health Care to stop the practice and reimburse patients who had paid the bills. The five-physician North Coast Pathology provides services to several hospitals but primarily Tri-City Medical Center, a 368-bed hospital that serves Oceanside, Calif. The hospital is about 40 miles north of San Diego and serves a sizable patient population, including the nearby Camp Pendleton Marine Corps base.
Balance billing is a practice wherein a provider seeks to obtain an amount for the service rendered beyond the deductibles and co-payments owed by an insured patient under their specific policy. The California Supreme Court ruled the practice illegal for emergency room services rendered within the state in early 2009.
According to the agreement between North Coast and the DMHC, it had been balance billing some patients of Anthem Blue Cross of California, Blue Shield of California, Aetna and Health Net since early 2009. All patient refunds will also include 7 percent annual interest payments. North Coast did not admit to any wrongdoing as part of the agreement.
The number of health plan enrollees and the amount they were overbilled was still being determined, according to DMHC spokesperson Rodger Butler.
A North Coast official declined comment on the matter.