The Public Employees' Health Care Act: billing disputes.

The Public Employees' Health Care Act (PEMHCA) allows an employee or annuitant to enroll in an approved health benefit plan, as specified. PEMHCA also authorizes the Board of Administration of the Public Employees' Retirement System to enter into contracts with carriers offering health benefit plans or with entities offering services relating to the administration of health benefit plans, as specified. The Knox-Keene Health Care Service Plan Act of 1975 requires billing disputes over emergency medical care to be resolved solely between the emergency room health care providers, who are entitled to a reasonable payment for their services, and the HMO, which is obligated to make that payment. The emergency room health care providers are prohibited from billing the patient for the disputed amount. Existing regulations define balance billing as an unfair billing pattern. This bill would prohibit a health care provider giving emergency services and care, as defined, from seeking reimbursement or attempting to obtain payment for any covered services provided to an employee or annuitant other than from the participating health benefit plan covering that employee or annuitant. The bill would specify that that provision would not apply to any copayments, coinsurance, or deductibles required for the covered services provided to that employee or annuitant other than from the participating health plan covering that employee or annuitant.