Hospitals charge a standard evaluation and management services fee ("EMS") for patients seen in the emergency room, in one of five amounts, depending upon the severity of the visit. This EMS fee is listed in the hospital's public "chargemaster," a comprehensive price list required by law. But does the hospital also have a duty to inform individual ER patients, before they receive services, about the EMS fee?
In a recent opinion, the California Supreme Court unanimously answered: No. A hospital's duty is to comply with the existing state and federal pricing disclosure laws that already require public disclosure of all of a hospital's fees, including its EMS fees. The Court's opinion, in Capito v. San Jose Healthcare System, LP, resolves a split of authority in the Court of Appeal regarding whether a hospital can be liable under state consumer protection laws for not individually informing ER patients about EMS fees before treatment.
The Supreme Court's decision relies heavily on the "extensive scheme of state and federal law" that "obligates hospitals to make specific disclosures about the prices of medical services." Capito v. San Jose Healthcare Sys. LP, Case No. S280018 (Dec. 23, 2024). These laws require every hospital to publish a copy of its chargemaster'a lengthy document describing the base charge for each of its procedures and services. Cal. Health & Saf. ' 1339.51(b)(1); 42 U.S.C. ' 300gg-18(e); 45 C.F.R. ' 180.20. The charges billed to patients is usually significantly lower than the base charges in the chargemaster due to reductions for insurance, discounts, charitable care or other reasons.
The California state agency governing health information access publishes chargemasters for free download on its website, along with other pricing disclosures. Hospitals must also publish a copy on their websites or at the hospital. Cal. Health & Saf. ' 1339.51; see also 42 U.S.C. ' 300gg-18(e) (similar federal law). In addition, hospitals must file with the state agency a form identifying its "top 25" most common charges'a short list typically including EMS fees. Cal. Health & Saf. ' 1339.56(c).
These pricing disclosure laws reflect the Legislature's desire to ensure consumers have access to pricing information regarding healthcare. But these are not the only policy goals expressed by the Legislature. As the Court explained, "emergency medical care is a vital public service that is necessary for the protection of the health and safety of all." Capito at...
