CMA Defends Noncontracting Physicians’ Right to Balance Bill
[Posted 02/17/05]

CMA recently filed an amicus brief defending the right of noncontracting physicians to balance bill patients for emergency services. In this case, Northridge Emergency Medical Group and St. John’s Emergency Medical Specialists, Inc., are fighting an appeal by Prospect Health Source Medical Group, which seeks to overturn a lower court decision affirming that right.

CMA in the brief explained that nowhere in California law are noncontracting physicians required to accept health plans’ discounted payment as payment in full for services provided to its enrollees. “Any attempt to deny noncontracting physicians the right to balance bill violates constitutional protections ensuring ‘fair and reasonable return,’” said CMA legal counsel Astrid Meghrigian.

CMA stressed that the Knox-Keene Act’s ban on balance billing applies only to contracted physicians. CMA pointed out that the act, which regulates managed care plans in California, specifically allows balance billing by noncontracting physicians.

Click here to download a copy of CMA's brief.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.