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. Worse 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.