At out-of-network emergency rooms, the challenge patients may face after treatment was to pay the unexpected list of the charges. These care units take care of the patients and provide ultimate care until they get stabled, but in the end, the patient may have to see the billings that he may not be able to pay for. Only those who have been contacted with the ER’s and the insurance companies can get little concessions or get treated freely.
In that case, companies would bear all the expenses until they have a contract with them. Gregory Pimstone, who leads healthcare litigation practice for Manatt Health, played a great role in bringing rights for such patients and worked to decrease the expenses patients have to bear at emergency care rooms as he is one of the leading litigators for health and has been recognized by Daily Journal. In-state of California, he is considered as one of the top 100 lawyers.
According to Gregory Pimstone, there should be a rational system imposed that focuses on implementing benchmarks for all kinds of patients having insurance policies or those who never want those. Different emergency departments charge differently. The basis of charges is as: triage fee, facility fee, professional fee, and supplies. At the time a patient gets admitted to an ER, he is unaware of these charges, but when he gets to know it’s out-of-pocket charges. So, in that case, if a patient has not signed a contract with the hospital, he should have some standards of paying the bills.
But now, the law was imposed, and no benchmark was set. The court gave one solution according to the case, Children’s Hospital Central California v Blue Cross of California, 226 Cal. App. 4th 1260 (2014), describing a willing patient may pay willingly to the seller, but still, there can be disputes because it doesn’t fit the budget criteria of the hospital. And different treatments charge the patient differently.
After having disputes and non-settlements and building a rational system, a law was passed known as the Affordable Care Act. This act was meant to encourage health coverage and insurance issues. Also, to manage the charges a patient has to pay at the out-of-network emergency unit. This act somehow decreased the crisis for the charges. It also increases insurance coverage expenses for those who cannot bear too many medical expenses and need proper medical care.
This law was set following the American Medical Association policy AMA, which also aims for providing standard medical care without paying much to the emergency rooms. Both laws worked in coordination to promote the better health of the public in California. Thus, somehow it decreased the crisis for the charges of the out-of-network emergency room. Gregory Pimstone also took part in this act. He investigated those who do violate the law by stopping the funds for the people who are insurance certified until getting stable, as this was a matter of serious consideration.