tci Part B Insider - 2006 Issue 10

PHYSICIAN NOTES: Emergency Room Physicians Can Charge Patients A 'Reasonable' Fee

Court rules that 'balance billing' isn't illegal in the ER It's not illegal for emergency room physicians to "balance bill" patients who belong to managed-care organizations (MCOs), a court ruled.When a managed-care patient comes into the ER, sometimes an emergency physician who belongs to that patients' MCO isn't available. In that case, a non-participating ER doc is legally required to treat the patient, and the MCO must pay the doctor. But the doctor doesn't have to accept the MCO's payment rate as payment in full, the Court of Appeals for the Second District of California ruled in Prospect...

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