Hospital Balance Billing in California

Nigel Whitehead — Thu, 16 Oct 2008 18:14:29 GMT

In California if you end up in the emergency room at least you don't have to worry about the bill since you have health insurance, right? Not so fast. This week a new rule was put in to place prohibiting hospitals from the so called practice of "balance billing". This means that if you end up in the hospital, particularly one outside of your provider network, you could be billed by the hospital for anything your insurance company didn't pay. This could be thousands and thousands of dollars. This week the California Department of Managed Health Care implemented a new rule banning this practice. You can read the Department's press release on this issue here.

But, before you head to the emergecny room without concern for the bill, be aware that a group of doctors and hospitals have filed a lawsuit challenging the new rule. They argue that many times the reimbursment rates from the insurance company is far below the amount needed to make a profit. And, since by law an emergency room is obligated to treat every patient regardless of insurance issues, they will lose billions of dollars.

The DMHC argues that the reimbursement issue will be addressed by regulations desgined to address unfair contracts giant health insurance companies are forcing on local medical providers that provide for very low payment rates for medical services.

As if the issue was not confusing enough, the California Supreme Court is set to hear oral aurguments in another case addressing this very issue - Prospect Medical Group v Northridge Emergency Medical Group -on November 5, 2008. You can see the California Supreme Court calendar here.

In a personal injury case this issue can have a huge impact on the settlemement of a case. If the lawyer can't tell with certainty how much - if anything - the client will owe to the hospital over and above the paid amount, it is impossible to tell the client how much the net settlement will be. This is an area that cries out for judicial and legislative clarity. Hopefully, the result will be fairness to the consumer, and not protection of the profits of giant corporations.

Originally posted at InjuryBoard by Nigel Whitehead

California Doctors and Hospitals Join Blue Cross Rescission - Cancellation Class Actions

Ray Mattison — Sat, 03 May 2008 19:31:19 GMT

The 35,000 member California Medical Association and the 450 hospitals of the California Hospital Association have joined the pending consumer class actions against Blue Cross complaining about the rescission (cancellation) of over 6000 customers by Blue Cross of California and it's subsidiary, Blue Cross Life and Health. "We believe that Blue Cross has failed to pay claims worth hundreds of millions of dollars based on its illegal practices," said Daron Tooch, one of the lead attorneys in this case.

Earlier this year Governor Schwarzenegger joined in the criticism of the rescission - cancellation practices of Blue Cross and other Health Plans, the subject of pending class actions in Los Angeles.

Blue Cross and other California health insurers are accused of doing little investigation (known as "underwriting" in insurane parlance) when the consumer applies for health coverage. Because they have a two year period in which they can rescind coverage if there is fraud in the application, the companies are accused of waiting until someone runs up large bills or becomes very ill and then doing an in depth scrutiny of the patient's medical history looking for reasons to deny coverage. According to the Los Angeles Times an investigation by the Department of Managed care found that "Blue Cross of California 'routinely' violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such 'harsh' treatment".

A recent legal victory by Raudel and Maria Rodriguez could spell more trouble for Blue Cross. According to their attorney, Robert S. Gianelli of the Los Angeles firm of Gianelli & Morris, Rodriguez and the other victims of Blue Cross' rescission - cancellation will now be able to present their case to a jury rather than being forced to binding arbitration. According to Gianelli and even the pro business Wall Street Journal, binding arbitration is not only shielded from the public eye, but is generally considered to be an expensive yet unfavorable forum for consumers. Along with the CMA's suit, the Rodriguez class action and others against the Blue Cross companies have been joined together in Los Angeles.

In association with San Luis Obispo attorneys Raymond E. Mattison and Don A. Ernst, current President of the Consumer Attorneys of California, Gianelli has brought a similar class action against Blue Cross Life on behalf of a San Luis Obispo County single mother whose health insurance was cancelled leaving her with unpaid medical expenses. A San Luis Obispo Judge recently certified a class action against Blue Shield brought by a young mother whose health coverage was cancelled after her son was born with a heart defect requiring expensive surgery. Blue Shield is also under investigation by the Deparment of Managed Care.

Originally posted at InjuryBoard by Ray Mattison

San Luis Obispo Personal Injury Lawyer - Hospital

Hospital Balance Billing in California

California Doctors and Hospitals Join Blue Cross Rescission - Cancellation Class Actions