Man Sues Health Net for Failure to Pay Emergency Room Bills

By Cecilia Green

Published on August 11, 2005

After his son received treatment at Los Alamitos Medical Center, Robert Cohen started receiving emergency room bills for services he believes should have been covered under his Health Net insurance, yet Health Net refused to pay. Eventually, ER doctors began billing Robert and when he did not pay, the matter was sent to a collection agency.

Robert Cohen argues that after making his co-payment to Health Net for emergency room services he should not be held responsible for the remainder of the bill that the insurance company refused to pay.

According to the Knox Keene Act, which contains the laws that govern insurance companies, it is illegal for an insurance provider to charge a subscriber for fees the insurance company agreed to cover.

When this case was originally brought to court, The Fourth District Court of Appeals decided that patients could not sue their HMO or other health insurance, but rather placed responsibility upon state regulators in the Department of Managed Health Care to enforce the law when insurance companies violate the Knox Keene act. This decision not only leaves individuals like Robert Cohen to suffer the consequences when state regulators do not take action to protect patients' rights, but it also conflicts with a recent case decision allowing doctors to sue insurance companies when they do not receive payment for medical treatments.

Supporting Robert Cohen, The Foundation for Taxpayer and Consumer Rights (FTCR) has written a letter to the Supreme Court requesting that the decision made by Fourth District Court of Appeals be overturned. The Supreme Court is expected to consider the petition from Robert Cohen and the FTCR within the next few weeks.

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