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Life After La Vida

By Andrew Selesnick
April 2014

Andrew Selesnick’s article, “Life After La Vida,” was published in the April 2014 issue of Lifeline, California ACEP’s monthly publication. The article discusses the California Court of Appeal ruling imposing greater reimbursement duties on HMOs.

From the article...

"As a matter of public policy, emergency providers are required to treat any patient who walks through the door regardless of ability to pay. In turn, health care service plans (HMOs) are obligated to reimburse the providers for an enrollee's care. HMOs frequently contract with independent practice associations (IPAs), delegating , among other duties, their reimbursement responsibilities. This arrangement has worked out well for the HMOs, who always get their premium payments for patients, with relative immunity. However, it has not always worked out so well for the emergency providers, especially when the IPAs experience serious financial trouble the renders them unable to pay."

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