Calif. Supreme Court protects patients from ER bills

Chris Rizo Jan. 8, 2009, 3:30pm

Ming Chin

SAN FRANCISCO (Legal Newsline)-Medically insured patients may not be billed for emergency care that their health plans refuse to pay, the California Supreme Court ruled Thursday.

The justices specifically said emergency room doctors may not directly bill the patient for any difference between the bill submitted and the payment received from the patient's insurer - a practice known as balance billing.

The high court's unanimous decision in Prospect Medical Group v. Northridge Emergency Medical Group overturns lower court rulings that sided with doctors and hospital groups that argued balance billing was not illegal.

"We conclude that billing disputes over emergency medical care must be resolved solely between the emergency room doctors, who are entitled to a reasonable payment for their services, and the HMO, which is obligated to make that payment," Associate Justice Ming Chin wrote for the court.

"A patient who is a member of an HMO may not be injected into the dispute. Emergency room doctors may not bill the patient for the disputed amount," he added.

California law requires emergency rooms to deliver medical care regardless of the patient's ability to pay.

"Our view is simple: It's just not fair for physicians to put patients in the middle of payment disputes with health plans. Today the California Supreme Court has gone one step further and said it is against the law," said California Association of Health Plans CEO Christopher Ohman.

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