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Solving Calif.’s Balance Billing Problem

Law360 (June 9, 2009, 12:00 AM EDT) -- On Jan. 8, 2009, the California Supreme Court banned emergency care providers from billing patients whose HMOs refuse to pay the providers’ full bill. In Prospect Medical Group Inc. v. Northridge Emergency Medical Group, [1] the court said that this practice, known as balance billing, improperly places patients in the middle of billing disputes between providers and HMOs.

Under the Knox-Keene Act, California’s comprehensive system of licensing and regulation of the managed health care industry, emergency care providers are required to treat patients without regard to...
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