Case Management

CMW News: California bans "balance billing"

Case Management Weekly, January 14, 2009

The California Supreme Court recently ruled that physicians can no longer bill patients for emergency room treatments that physicians feel HMOs do not adequately pay.

HMOs and patient advocates celebrate the decision as a way to stop physicians and hospitals from overcharging for emergency services. Physicians say the court has taken away their only leverage against HMOs to receive fair payments, and this ruling may put emergency departments in economic jeopardy.

Regulations require HMOs to pay physicians and hospitals reasonable amounts, but do not specify what constitutes reasonable.

Sources: HealthLeaders Media, Los Angeles Times


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