In a long-awaited ruling, the California Supreme Court has banned the practice of balance billing for emergency serviceswhere providers directly bill patients for the balance unpaid by insurance companies.
The case, Prospect Medical Group v. Northridge Emergency Medical Group, overturns a prior appeals court ruling affirming the practice.
California last year became the first state to ban balance billing for emergency services by Gov. Arnold Schwarzeneggers order and subsequent regulations. The California Medical Association and California Hospital Association are suing the state over the regulations in a separate case.
In its interpretation of state statutes on the books, the states highest court unanimously concluded that billing disputes over emergency medical care must be resolved solely between the emergency room doctors who are entitled to reasonable payment for their services, and the HMO, which is obligated to make that payment. A patient who is a member of an HMO may not be injected into the dispute.
The seven judges declined to address a contested aspect of the states new regulations: defining balance billing as an unfair billing pattern. We need not get into such matters, the court wrote in its decision, filed in Los Angeles County Superior Court.
Cindy Ehnes, director of the state Managed Health Care Department, said in a written statement that the ruling confirms regulatory action taken last year to protect consumers from balance billing.
The California Medical Association said in a written statement that the ruling forces physicians and hospitals to eat the cost of emergency medical care that HMOs refuse to cover, adding it is exploring options to ensure that physicians have adequate recourse when HMOs fail to pay reasonably for emergency services.
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