California Supreme Court bans ER 'balance billing'
Posted Jan 11 2009 4:20pm
This is good news for patients in not having to battle the insurance companies, but perhaps not so good for the doctors, as the president of the CMA (California Medical Association) states below, I guess I have to go to court.
But when you look at this, it should not be a battle between doctors and patients to begin with, it’s the other party, the insurance carriers who created the situation. With contracts getting lower all the time and the need to almost have an attorney these days to interpret what is covered and for how much, how can anyone win here. Similar battles with payments from insurers are going on in Massachusetts with Tufts getting ready to end their contracts with Blue Cross, so it’s back down to “will someone please pay this bill”.
I certainly want to have a physician available to take care of me, and yes I feel he/she should be paid for their time too, but when complicated algorithms or formulas are run after the fact, like a Monday morning quarterback of sorts, how can you win? Sure, there could be room for errors and those issues should be looked at, but again it’s the risk management formulas that tend to be ruling healthcare today and not the pursuit of better healthcare. If the HMOs contracts were not so low on compensation and complicated, then none of this would have probably ever taken place. BD
The California Supreme Court ruled Thursday that emergency room doctors can’t bill patients when their health plan doesn’t pay enough to cover their bills.
In an unanimous ruling in Prospect Medical Group v. Northridge Medical Center, the high court said the matter must be resolved between doctors and patients, therefore prohibiting doctors from “balance billing” patients to recover their costs.
Gov. Arnold Schwarzenegger, whose Department of Managed Care issued regulations last year banning the practice, applauded the court action. So did the HMO industry. Doctors blasted it for forcing doctors and hospitals to eat the cost of emergency medical care HMOs refuse to cover.
“As a trauma surgeon, my No. 1 priority is to save lives and protect the health of my patients,” CMA president Dr. Dev GnanaDev said in a press release. “This court ruling basically says if I do my job as I see fit and HMOs don’t want to pay, tough luck, go to court. I signed up to be a doctor, not a lawyer.”