There is news in California that the Supreme Court has unanimously ruled against balance billing, a practice utilized by emergency room doctors to bill patients and auto and motorcycle accident victims for the amounts their HMOs don't pay. This personal injury lawyer applauds the decision and the fairness it brings in no longer causing car accident victims to wonder if their HMO will pay their emergency room bill in full or if they may even be put into collection for the unpaid balance.
In a unanimous ruling on January 8, 2009, the California Supreme Court has ruled that emergency room doctors can no longer bill patients for the balance when they feel the patient’s HMO has underpaid them.
Governor Schwarzenegger praised the ruling, stating “it reaffirms that patients should not be put in the middle of billing disputes between providers and health plans.” He further stated, “This ruling will protect Californians who have done the right thing by obtaining insurance, but then later receive burdensome medical bills that they do not owe.”
While critics of the ruling argue that the ruling will hurt emergency rooms that are already in bad financial shape, consumer
s feel that the ruling is great for patients who are equally financially strapped and now have a large economic burden lifted from their backs.
For personal injury victims in California and their lawyers and for those auto accident attorneys, it simplifies matters a great deal in determining what liens exist on their personal injury client’s cases. But the ruling is huge for another reason. According to a 2007 study, over 1.76 million insured patients went to emergency rooms in the previous two years and received bills for the balance of what their HMO had not paid on their bills.
What this ruling does is define balance billing for out-of-network emergency services as an unfair billing practice, according to California physicians who will likely appeal the ruling.
When HMOs have not paid the full amounts of emergency room bills in the past, patients and personal injury victims have been sent bills by the hospitals, by the emergency room physicians, by their billing services and even by collection agencies for the differences. With this ruling by the California Supreme Court in 2009, those bills should be invalidated.
It’s bad enough that car accident victims have been injured without worrying whether their HMOs will pay the bill in full or whether they will be billed by the emergency room for the balance and put into collection if they don’t pay the balance.
It is thought by many that hospitals and physicians submit inflated bills to HMOs just because HMOs routinely pay only a portion of those charges. It is therefore unfair that patients and personal injury victims should then be billed for the balance of those possibly inflated charges just because their HMO chose not to pay the entire amounts. Physicians have bristled at claims that they would overcharge or inflate their bills.
The California Supreme Court overturned lower court rulings that had allowed doctors to balance-bill their patents for amounts that their HMOs had not paid. The Supreme Court said that the statutes that regulated emergency care express an intent to “transfer the financial risk of health care from patients to providers.”
As a result of the ruling, emergency room doctors must now resolve their differences with HMOs and not inject patients into the dispute. However, many doctors now fear that the ruling could strain already financially strapped emergency rooms and may also discourage emergency room specialists from getting involved in emergency room cases. One also has to wonder if this ruling could cause HMOs to further raise their insurance rates.
The difference between what HMOs reimburse hospitals for emergency room charges and what hospitals charge is believed to total $200 million annually.
