CSPMR in Action!Children’s Hospital contracted with Blue Cross of CA until 2007. When their contract expired in 2007, Children’s Hospital treated Blue Cross of CA patients without a contract for 10 months. Blue Cross said that since Children’s Hospital accepts Medi-Cal, they will reimburse at Medi-Cal rates. Children’s Hospital argued that if there is no contract, they should be able to bill and receive their usual and customary fees. The court ruled in favor of Children’s Hospital and the case was then taken to the Court of Appeals and it was overturned in favor of Blue Cross of CA!
Implications - This is not the first court case arguing this matter. Up until this case, all were either settled or ruled in favor of the physician. This is the first case that made it through the court and to the Court of Appeals. If it is not overturned, it will become legal precedent. Worst case scenario, the insurer can argue that if there is no contract, the physician should be paid their lowest fee schedule. In the case of Children’s Hospital, it was Medi-Cal. What about people who do volunteer work or treat some patients for free?
CSPM&R will write an amicus letter to the Supreme Court of California requesting that they hear this case. The CSPM&R board passed this by unanimous vote.
UpdateCSPMR sends a letter requesting a hearing on the above appellate court case on Supreme Court review, and hopefully will overturn its decisions. Click here to view the letter CSPMR sent to the California Supreme Court.
Proposition 46 updateThe CSPM&R board vote to oppose Proposition 46, the proposition that will overturn MICRA disguised as the “patient protection act.”
The California Society of Physical Medicine and Rehabilitation supports and encourages its members to vote NO on Proposition 46. The following are answers to frequently asked question (FAQ):
1. What is Proposition 46?
Proposition 46 is a thinly veiled proposed legislation constructed with the primary intent of overturning the Medical Injury Compensation Act of 1975 (MICRA). The major intent of the proposition is to increase the cap on medical malpractice from $250,000 to $1.1 million.
2. What is MICRA?
The Medical Injury Compensation Act,MICRA, allows patients with justifiable medical malpractice claims to receive the following forms of compensation:
• Unlimited economic damages for past and future medical costs.
• Unlimited damages for lost wages, lifetime earning potential or any other economic losses.
• Unlimited punitive damages.
• Up to $250,000 for non-economic damages. Unlike economic damages, non-economic damages are inherently subjective and often difficult to verify and measure. MICRA’s $250,000 ceiling on non-economic damages has proved effective in reducing and stabilizing medical liability insurance costs, which in turn has limited the rate of growth in health care costs and increased access to health care for all Californians.
3. Unlimited seems like it should be enough money. Does proposition 46 ask for more?