Key Observations by Gregory Pimstone on The Inefficient Paying Out-of-Network Emergency Care System

The reimbursement and administration of emergency room care out-of-network payment system are among the most confusing and inefficient processes in the USA today. It desperately needs a significant change as the entire process is time-consuming, unnecessary, and highly expensive. An eminent healthcare lawyer from Los Angeles is currently voicing his dissent on the system and crying out to the legislature to make changes in the process to benefit everyone.

Gregory Pimstone discusses the problem in detail

There is a lot of confusion regarding how emergency room care is administered in California today. An eminent legal expert is now raising his voice to draw attention to the problem and why it needs to be arrested. The current ER care administration and reimbursement process are inefficient to such an extent that it actually has no defined purpose. The process is cumbersome, expensive, and only increases legal and financial problems for the parties in the case. It serves no benefits except for the lawyers hired for fighting litigation cases pertaining to the above clogging the courts of law in the state.

Gregory Pimstone recommends a solution to this problem

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Gregory Pimstone is a credible healthcare lawyer from Los Angeles and is the head of the healthcare law group at national law firm Manatt in the USA.  He goes on to say every ER is obligated under law to treat a patient for emergency care even if his/her healthcare plan is not under a contract with the hospital. No ER can refuse to treat a patient, and every healthcare plan will pay for the services rendered until the patient is stabilized. The above is crystal clear and makes perfect sense.

The law lays down no provision

The financial and legal woes of the system surface when the ER and the healthcare carrier fail to reach an agreement when it comes to the reasonable costs of the service. The law has no provisions to determine what this fixed value should be or how it should be calculated. The matter is taken care of by managed healthcare plans that determine the costs using a method set by the regulator.

The ER is not obligated to accept the payment decided and can proceed to sue the carrier in the court of law if dissatisfied. The case is heard, and if one party loses the case in a trial court, appeals for hearing the case again are made. There is a lot of money, time, and valuable resources wasted in the whole process.

The problem gets worse daily

Obviously, multiple cases are pending in court as patients walk into ER care units regularly, so similar cases are filed in court. No one is benefitted except the legal experts and lawyers hired to fight the case.

Gregory Pimstone of Manatt concludes a law should determine how such reasonable costs for out-of-network ER care should be administered for reimbursement. The State Legislature should take note of the issue and step in to fix a method for determining the above easily. In this way, this unnecessary litigation can be curbed, and the system becomes more streamlined and organized.