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.
