SPECIALISTS: Managed Care at the Root of ER Problem
In a letter to the editor in today's Los Angeles Times, Dr. Gerald Schiff, co-chair of the Emergency On-Call Task Force, and Dr. Francine Hanberg, vice president of the Los Angeles County Medical Association, add their names to the chorus of those applauding emergency room doctors for their rebellion against managed care. Seconding a June 11 op-ed, they write that "if health plans advertise that they offer a full range of specialty services, those plans are obliged to ensure that a panel of physicians providing those services is, in fact, available." But many plans do not arrange such panels, opting instead to retroactively deny payment for specialist care provided in an emergency setting, knowing full well that "physicians will almost always help those in need." Schiff and Hanberg write that the task force found "physicians rarely refuse to treat patients who are on Medi-Cal or have no insurance. Many, however, have become reluctant to see subscribers of plans that have repeatedly denied payment for services already verbally approved. We know of no other profession whose members routinely provide such services with virtually no hope of compensation" (6/21).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.