FW: Supreme Court Rebuffs Effort to Allow Health Plans to Continu e Dodging Payment for ER Services

[Kazzi, A. Antoine]

Read this one very carefully.

This a great victory for EM. 

It goes to show the importance of contributing to our united California
EMPAC and to your state professional societies!

Bravo to CMA, CAL/ACEP who led this battle against managed care and health
plans to underpay EPs for their services!

Bravo to our California AAEM members who support the GAC, EMPAC, the CMA and
the state legislative activities.

Antoine Kazzi, MD, FAAEM
President
The American Academy of Emergency Medicine

-----Original Message-----
From: CAL/AAEM News Service
To: calaaem at uci.edu
Sent: 6/1/2004 6:36 PM
Subject: Supreme Court Rebuffs Effort to Allow Health Plans to Continue
Dodging Payment for ER Services

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 knew-or should
have known-that the
intermediary was financially unstable. 

For more information, go to http://www.calphys.org/html/bb590.asp  

Contact: CMA's 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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