In a somewhat shocking decision, the California Supreme Court recently agreed with the Schwarzenegger administration that physicians who are non-participants in a patient’s health insurance coverage plan may not charge usual and customary fees exceeding the insurance reimbursement to the patient in ER and on-call care. This has to be unconstitutional on its face. But it speaks to the angst about rising costs. Unfortunately, many California doctors may feel they can no longer take call, given low insurance reimbursement, no reimbursement from many patients, and high malpractice risk

The rising costs of health care are causing similar seemingly draconian actions on many fronts. But when doctors are unable to negotiate fair compensation contracts with insurers, they ought to have a right to go outside the insurance company and still see patients, who have the right to choose a different doctor. The California law pertains to EMTALA-related care where patients often do not have the option to choose another doctor, or shop around for better charges, but it is likely to be interpreted broadly by the insurance companies, which could see it as a means of paying whatever they want and giving physicians no recourse for negotiating fair reimbursement. Just more troubling signs of the times, and another reason we need real national payment reform.

< Back to Listings