Supreme Court of California

In a case involving the propriety of emergency room doctors' practice of "balance billing" of patients who are members of HMOs (but whose HMO's did not pay the full balance of their ER bills), the California Supreme Court rules that billing disputes over emergency medical care must be resolved solely between ER doctors, who are entitled to a reasonable payment for their services, and a patient's HMO, which is obligated to make that payment. A patient who is a member of an HMO may not be injected into the dispute, and ER doctors may not bill the patient for the disputed amount.

Appellate Information

• Decided 01/08/2009
• Published 01/08/2009

Judges

• CHIN, J.

Court

• Supreme Court of California

Counsel

• For Appellant:
  
• Bird, Marella, Boxer, Wolpert, Nessim, Drooks & Lincenberg, Thomas R. Freeman, Los Angeles;  Miller & Holguin, Stephan, Oringer, Richman, Theodora & Miller, Theodora Oringher Miller & Richman, Harry W.R. Chamberlain II, Kenneth E. Johnson, Robert M. Dato and Stacey L. Zill, Los Angeles, for Plaintiffs and Appellants., Epstein Becker & Green, William A. Helvestine, Michael T. Horan and Carri L. Becker, for California Association of Health Plans as Amicus Curiae on behalf of Plaintiffs and Appellants., Fulbright & Jaworski, Buchalter, Nemer, Fields & Younger, Buchalter Nemer and Carol K. Lucas, Los Angeles, for California Association of Physicians Groups as Amicus Curiae on behalf of Plaintiffs and Appellants., Amy L. Dobberteen, Debra L. Denton, Michael D. McClelland, Sacramento, and Drew Brereton, for Department of Managed Health Care as Amicus Curiae on behalf of Plaintiffs and Appellants.


• For Appellees:
  
• Howard Rice Nemerovski Canady Falk & Rabkin, Jerome B. Falk, Jr., Ethan P. Schulman, Steven L. Mayer, Jonas M. Nahoum, San Francisco;  Law Offices of Andrew H. Selesnick, Alleguez & Selesnick and Andrew H. Selesnick, Santa Ana, for Defendants and Respondents., Catherine I. Hanson, for California Medical Association as Amicus Curiae on behalf of Defendants and Respondents., Astrid G. Meghrigian, San Francisco, for American College of Emergency Physicians, California Chapter of the American College of Emergency Physicians and California Chapter, American Academy of Emergency Medicine as Amici Curiae on behalf of Defendants and Respondents., Physicians' Advocates and Charles Bond, Berkeley, for American Medical Association as Amicus Curiae on behalf of Defendants and Respondents., Hooper, Lundy & Bookman, Lloyd A. Bookman, Suzanne S. Chou and Felicia Y Sze, San Francisco, for California Hospital Association as Amicus Curiae on behalf of Defendants and Respondents.