Well it appears Prime Healthcare is not alone in California with balance billing. This is truly the no-win situation in healthcare where patients, hospitals and doctors are pit against one another over insurance payments or non payments on balances owed. It is hard today to figure out what will be paid for at times as the algorithms that calculate are more complicated than ever. Just recently with United HealthCare, their subsidiary company, Ingenix was put out of business for scrutinizing claims and they made 1.3 billion last year. BD
SAN DIEGO — A class action lawsuit filed in San Diego Monday alleges that over the past four years, Scripps Health billed a class of emergency medical patients for services after their HMOs refused to pay their entire bill.
The lawsuit alleges that Scripps Health and co-defendant La Jolla Emergency Physicians Medical Group, illegally engage in the practice of "balance billing'' of their emergency medical services patients.
Balance billing occurs when a dispute arises between a medical service provider and Health Maintenance Organization over the reasonable value of medical services provided and the HMO refuses to pay the full amount of the bill submitted.
Rather than pursue the HMO, the medical service provider bills the patient for the unpaid amounts in dispute.