Centinela Freeman etc. v. Health Net of California, S218497

Health care: Emergency medical services: HMO: Both state and federal law require any licensed hospital that has appropriate facilities and qualified personnel to provide emergency medical services or care regardless of a patient’s ability to pay. (Health & Saf. Code, § 1317, subds. (a), (b); 42 U.S.C. § 1395dd (b), (h).) If the patient is an enrollee in a health care service plan, the plan is required by statute to reimburse the emergency service provider for necessary emergency medical services and care. (§ 1371.4, subd. (b).) Plans are permitted, however, to delegate this financial responsibility to their contracting medical providers. (§ 1371.4, subd. (e), hereafter section 1371.4(e).)

Health care service plans are defined in section 1345, subdivision (f). They are commonly known as health maintenance organizations or HMOs. (Watanabe v. California Physicians’ Service (2008) 169 Cal.App.4th 56, 59, fn. 3.) 

(Cal. S.C., November 14, 2016, Centinela Freeman etc. v. Health Net of California, S218497).

Décision qui expose de manière complète les diverses responsabilités financières des intervenants dans la chaîne du système de santé, et les conséquences en cas de défaillance économique de l’un d’eux.