ER doctors bank on appeal to get default protection. (Health Care).

AFTER failing in Sacramento to make sure they get paid or emergency services provided to insured patients, physicians are now banking on a lawsuit against PacifiCare Health Systems Inc. to get them relief.

Emergency room physicians are often not paid directly by insurers, but by medical groups that have subcontracted with a patient's health plan and that include a patient's primary care doctor.

Dozens of such groups and independent practice associations have failed over the past several years, leaving ER physicians in the lurch. In such cases, doctors want to go directly to insurers for payment.

"When someone has insurance we should get reimbursed for the services we deliver," said Dr. Mark Spiro, chief operating officer of California Emergency Physicians Medical Group.

The group is the largest partnership of emergency medical physicians in the state and its members were left with $200,000 in unpaid bills at two San Diego hospitals two years ago after a medical group called Family Health Networks closed down.

Earlier this year, the emergency physicians group sued PacifiCare, which had contracted with FHN, seeking the money directly from the Cypress based insurer. The Superior Court lawsuit was dismissed before trial, but now the physicians have taken the case to the state Court of Appeal, where the California Medical Association has joined in support.

Last year, the Legislature passed a bill that would have required health plans to make good on such bills. But the governor vetoed it on the grounds that it would interfere with the relationship between health plans and medical groups, which assume risk in providing care for plan members.

PacifiCare issued a statement that it believes it will prevail in the appeal.