Prospect Med. Group v. Northridge Emer. Med. Group
The facts and procedural history of this case are set forth in detail in the first opinion and in Prospect. Court incorporate by reference the factual and procedural background section of Prospect. The following is a brief summary of the facts.
Prospect is a delegate of health care service plans (plans) and is statutorily obligated to pay for emergency medical services provided to patients who have subscribed to those plans (Prospect members). In general, Prospect members are provided medical services by health care providers who have a contractual relationship with Prospect. However, Prospect members may seek emergency medical care from emergency room physicians who do not have a contract with Prospect. When that occurs, Prospect must reimburse the non-contracted health care providers who provided services to Prospect members.
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