California Supreme Court Ruling on Prospect Medical Group, Inc., et al., v. Northridge Emergency Medical Group et al.

January 8, 2009 The California Supreme Court ruled that patients cannot be held liable for the balance between what health maintenance organization (HMO) providers want to pay for emergency room services by out-of-network providers. The ruling means an end to the practice of balance billing, in which the patient receives a bill from a provider for the remainder of the bill left after the patients insurance pays the provider. Billing disputes over emergency care must be resolved between the provider and the HMO obligated to make that payment. The ruling applies only to consumers enrolled in HMOs in . . .