This is a victory for patients and California consumers. I’m talking about the California Supreme Court’s decision, which firmly establishes that emergency room physicians may not go after patients to collect any remaining balance remaining after being paid for their services by the patient’s HMO. Before the court’s decision ER physicians had this practice of hounding patients to pay additional bills for emergency services, often sending collection agencies after them. Our source for this blog was this news report in the San Francisco Business Times.
How big is this problem? A 2007 study by the California Association of Health Plans, an HMO industry group, reports that more than 1.8 million insured Californians who visited emergency rooms between 2005 and 2007, received bills on top of their copayments and deductibles. The average bill was $300, translating to an overall tab (for that two-year period) of $528 million.
State law requires that ER physicians perform emergency services to stabilize a patient. If the patient has HMO, then the HMO is required to pay for such emergency care. The problem, however, is that in emergency situations, HMOs may not have had a prior contract with the physician who is performing that service. So there has been increasing friction between the HMOs and emergency physicians about the discrepancy between what the HMOs will pay and what the physician has billed or will accept. This situation has forced many ER physicians to bill patients directly for the balance.
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