This ruling puts emergency physicians in a hard spot, but protects consumers. This goes back to the Prime/Kaiser scenario and more can be found under the related reading section here. There is a separate case pending with the California Supreme Court, so the matter is not closed yet by any means, so stay tuned.
Who really suffers from all of this are the smaller practices and hospitals to a degree and it comes back around to low compensation 
contracts from insurers in California, which are some of the lowest in the country. Who’s going to pay the bill?
In the meantime in the midst of this situation, Blue Cross has found its way to find 101 million to start a Venture Capital Corporation, I can’t help but think that the 101 million could have certainly contributed to the payment of many claims. All insurers sit on one big hay stack of money, could even be up to a few trillion across the country at this point, but a related post shows the amounts of just 3 carriers in the state of Washington a couple years ago and no doubt it has grown so do the math and multiply this across 50 more states and add in a few hundred additional carriers and that might give an idea as to the cash stockpiles. In Pennsylvania the legislators have been asking questions about such reserves.
“Capital maintains a financial surplus, as do the state's three other BlueCross and BlueShield plans. The Blue plans have been forced to justify those surpluses to regulators and legislators.
They have maintained that the surpluses, and the resulting investment income, help them to cushion the impact of medical cost inflation and would help keep them solvent in the event of something such as a flu outbreak that would cause widespread hospitalizations.”
So what is the answer here, the carriers say they need the large reserves in case of a gigantic flu outbreak, but in the meantime consumers go without the healthcare they need and some are dying in the effort. California has even brought the insurers to task as well demanding for a certain percentage to be dedicated to paying claims, but as mentioned above, profits are allowing for the creation of new Venture Capital Companies, and where the money goes who knows, so far only one software company funding has been announced and it is the business of risk management and not directly towards better healthcare.
There’s also a pilot program going on with Blue Cross to begin covering surgeries done in India as it is cheaper, so where is all of this leading to, a trip on the “Brokeback Jet” to another country to get healthcare in our future? BD
California physicians suffered a setback in the effort to block the “balance billing” regulation this week when Sacramento County Superior Court Judge Michael Kenny denied the California Medical Association’s (CMA) petition to invalidate regulations promulgated by the California Department of Managed Health Care (DMHC) that prohibit physicians and hospitals from “balance billing” for emergency care.
“Balance billing” is the practice of billing patients directly for outstanding out-of-network care costs not covered by health plans. Balance billing has been a remedy to address nonpayment or underpayment by HMO’s and health plans; physicians could seek payment of “usual and customary” fees not only from the plans, but from the patients enrolled in the plans when the plans failed to pay. Until the regulations took effect, the only constraint on balance billing were contractual provisions in health plan contracts that prohibited billing patients for “covered services.”
The DMHC policy appears to have emerged as a negative reaction to a single provider, hospital system Prime Healthcare, which balance billed thousands of Kaiser Permanente HMO patients for out-of-network emergency care.
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