Supreme Court Rebuffs Effort to Allow Health Plans to Continue
Dodging Payment for ER Services
CAL/AAEM News Service
calaaem_news at yahoo.com
Tue Jun 1 18:36:04 PDT 2004
Supreme Court Rebuffs Effort to Allow Health Plans to Continue Dodging Payment for ER
Services
May 27, 2004
The California Supreme Court recently denied a request to limit the reach of a recent
appellate court ruling that would prevent health plans from shirking their payment
responsibilities when they contract with intermediaries they know to be financially
unstable.
Earlier this year, the Sixth District Court of Appeal had ruled that health plans in
certain circumstances must pay for emergency services provided to its enrollees by
non-contracting physicians, even though the plan has delegated its payment
responsibilities to a contracting intermediary. In the ruling, Appellate Judge J. Coffee
concluded that even though a health plan can legally contract its payment
responsibilities to a third party, the plan can be held liable for payment if it
negligently contracted with that intermediary when it knewor should have knownthat the
intermediary was financially unstable.
For more information, go to http://www.calphys.org/html/bb590.asp
Contact: CMAs legal information line, 415/882-5144 or legalinfo at cmanet.org.
Source: CMA Alert
=====
Cyrus Shahpar & Brian Potts
Managing Editors, CAL/AAEM News Service
UC-Irvine
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