Health Maintenance Organizations

Winding up in the emergency room is bad enough. But the California Supreme Court ruled Thursday that patients no longer have to worry about getting billed for emergency treatment charges that their HMOs fail to pay. Health maintenance organizations and patient advocates hailed the decision as an important protection against gouging by hospitals and physicians.

The nonmobile, hard lump had been on my sternum (the bone in the center of the chest) for many months. As a physician, I had figured it was costochondritis -- an inflammation -- from years ago that had hardened with age.

Gov. Arnold Schwarzenegger's administration has moved to ban physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay.

In 2002, California's HMO czar, Daniel Zingale, declared, "The days are over when they could make patients wait and wait for healthcare." Zingale was heralding a new law that required his department to ensure that HMO patients received timely appointments with doctors.

Many Californians enrolled in healthcare plans are receiving inadequate preventive care, a government report said Thursday. The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.

A highly unusual battle erupted in a San Diego courtroom Friday, with parents of a severely premature baby seeking to force healthcare giant Kaiser Permanente to move their son to a better-equipped hospital in hopes of saving his life.

Eight months after pledging to put the brakes on retroactive cancellations of individual health insurance policies, the state agency that regulates HMOs said Tuesday that new rules were taking longer than anticipated because of the variety of health plans involved.

Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators.