Delegated Obligation: The Law Says E.R. Doctors Have To Treat Patients, And The Doctors Want To Get Paid.

The law imposes a duty on emergency room physicians to treat patients regardless of their ability to pay. When those patients are enrollees in health care service plans (HMOs), the law imposes an obligation on the HMOs to reimburse the physicians for emergency treatment provided to the enrollees, even when the physicians were not under contract to the HMOs. HMOs sometimes delegate their health care obligations to independent practice associations (IPAs); HMOs are statutorily permitted to delegate to IPAs their obligation to reimburse emergency physicians. In this case, the IPA failed to reimburse emergency room physicians, so the doctors sought payment from the HMOs. When payment was not forthcoming, the emergency room physicians brought an action against the HMOs, and the trial court granted defendants’ demurrer.  The appellate court reversed, holding that when an HMO knows or has reason to know the IPA would be unable to fulfill the delegated obligation, the loss should be borne by the HMO and not the physician who is obligated by statute to provide emergency care.  (Centinela Freeman Emergency Medical Associates v. Health Net of California, Inc. (Cal. App. Second Dist., Div. 3; February 19, 2014) 223 Cal.App.4th 1366, [168 Cal.Rptr.3d 91] Superseded By Grant Of Rehearing (Cal. App. Second Dist., Div. 3; April 2, 2014) (Case No. B238867a).)