Thursday, January 08, 2009

Prospect Medical Group v. Northridge Emergency Medical Group (Cal. Supreme Ct. - Jan. 8, 2009)

I won't say much about this opinion except to say that (1) it's important to anyone who's in an HMO in California, and (2) it's unanimous, which I think tells you a little bit about the merits. Justice Chin holds that even if the HMO doesn't have an agreement with an emergency room physician, the physician can't bill the patient ("balance bill") for any amount charged by the doctor that the HMO decides it won't pay. The HMO and doctor instead have to work out the dispute solely between themselves.

It makes HMOs more attractive (or at least less unattractive) to prospective subscribers. And protects patients. So not surprising that the case turns out the way it does.