PacifiCare wins ruling over costs of ER care.EMERGENCY room doctors lost a recent state Court of Appeal decision over who is responsible for coveting emergency care costs when medical groups collapse. The 4th Appellate District panel in Santa Ana Santa Ana, city, El Salvador Santa Ana (sän'tä ä`nä), city (1993 pop. 129,873), W El Salvador. It is the second largest city in the country and the commercial and processing center for a sugarcane, coffee, and cattle region. sided with PacifiCare of California last month, upholding a lower court's decision throwing out a ease brought by the California Emergency Physicians Medical Group. The San Diego San Diego (săn dēā`gō), city (1990 pop. 1,110,549), seat of San Diego co., S Calif., on San Diego Bay; inc. 1850. San Diego includes the unincorporated communities of La Jolla and Spring Valley. Coronado is across the bay. doctors sued the Cypress health plan last year in Superior Court, alleging that the HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, was responsible for more than $100,000 in unpaid bills after a medical group called Family Health Networks closed down. Emergency room doctors in California are often paid by medical groups that contract with a patient's insurer to provide primary, specialist and hospital care. The physicians claimed PacifiCare had to pay once FHN FHN Forest Hills Northern failed, since doctors aren't allowed to turn away a patient needing emergency care. The HMO contended it already had discharged that obligation to the medical group, under a contract that paid Me medical group to take are of the patient. The appellate panel said state laws allow HMOs to transfer risk to intermediaries like FHN. "If the decision stands, a health plan can delegate payment of emergency services emergency services Emergency care '…services …necessary to prevent death or serious impairment of health and, because of the danger to life or health, require the use of the most accessible hospital available and equipped to furnish those services' to a drunken sailor Drunken Sailor is a famous traditional sea shanty also known as What Shall We Do with the Drunken Sailor?. It is now rarely called by its other name Sailor’s Holiday. and walk away," said Ian Guthrie, an attorney for the doctors' group, which is considering an appeal to the state Supreme Court. However, insurers said any other decision by the appeals court would have undermined the underlying structure of managed care. "Providers should be paid, but to require the plans to pay twice turns the statute on its head," said Peter Roan roan a coat color consisting of a relatively uniform mixture of white and colored hairs, giving a 'silvered' hue; self-describing colors are red-roan, blue-roan, chestnut roan. , an attorney representing PacifiCare. Two years ago, Gov. Davis vetoed a bill that would have required health plans to make good on the charges when there was a failure of an intermediary medical group. PacifiCare ended up citing that veto in its legal papers to show that indeed state law was clear on the issue. Staff reporter Laurence Darmiento can be reached at (323) 549-5225 ext. 237 or at ldarmiento@labusinessjournal.com. |
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