Dr. Martello has filed a balance billing lawsuit against his former employer. He has argued that he was never a true emergency room physician and was only performing cosmetic services on stable patients. His attorney, Michael Gonzalez, has outlined the case in detail. This is a good read for anyone interested in the legalities of balance billing. Fortunately, for patients, there are several options available for resolving a medical debt.
Haller suing the federal government over No Surprises Act
In his suit, Haller is targeting a bipartisan measure intended to protect patients from unexpected medical bills. The federal No Surprises Act limits the amount a physician can charge outside his or her network of providers. The law was introduced to protect all patients from high out-of-network costs, which can drive up the cost of health insurance. Haller’s lawsuit could be a blow to the law and its supporters.
The No Surprises Act was implemented in 2001, but it has yet to be fully rolled out. Haller has long complained about its requirements. His lawsuit has widespread support. In the past, the American Medical Association and the American Hospital Association have filed a joint suit against the law, which allows arbitrators to rely on in-network rates. The plaintiffs appealed that ruling, and the federal government has now appealed the ruling. In the meantime, a court hearing is scheduled for June 7, and the plaintiffs are appealing the ruling.
Haller argues entire law should be thrown out
Dr. Daniel Haller is one of the patients fighting the No Surprises Act. The law aims to protect patients from unexpected bills when doctors are out-of-network. Haller says the law violates his constitutional rights and should be struck down. His suit will be heard in federal court in Manhattan. It will be interesting to see how the court rules. But before it does, Haller argues that the entire law should be struck down.
Many medical associations agree with Haller’s goal of protecting patients from unfair bills. They also dispute some aspects of the law’s underlying premise, which is independent dispute resolution. That is, the law provides an arbitration process that helps insurers and out-of-network providers reach a price agreement. Haller argues that this process leaves the patient out of the bargaining process. This goes against the entire purpose of the law, which is to protect patients.
Garretts’ case
Despite the benefits of being covered by a health insurer, the excessive amount of balance billing at hospitals is a major concern for many people. This litigation argues that balance billing is not illegal, so long as a hospital does not seek reimbursement from health plans it does not contract with. In this case, the plaintiff, Garrett Motion Inc., has sued both Prime and four other defendants. The other defendants include Honeywell International Inc., Honeywell ASASCO LLC, and Su Ping Lu. Honeywell’s CEO, Darius Adamczyk, has also joined the case.
Dr. Martello’s case
In December 2010, the California Department of Managed Health Care issued a cease and desist order against Dr. Martello. The California Department then sued Dr. Martello in state court in Los Angeles County. In May 2012, Los Angeles Superior Court Judge David Milton issued a preliminary injunction against Dr. Martello, which was later made permanent on November 15, 2012. The judge ordered Dr. Martello to cease filing any lawsuits against emergency-care patients.
However, Martello’s argument that he was negligent was not raised in the trial court. He failed to provide the necessary testimony to support this claim. Instead, the doctor presented an inconsistent defense. Although the defendant did not dispute Martello’s arguments at trial, his lack of presentation of evidence is an issue of first impression. The plaintiff has ample opportunity to present a compelling case on appeal but has failed to do so.
Legal battles against balance billing
As a consumer, you have the right to know whether you are being charged more than you should for medical services. However, the new laws designed to protect you against balance billing may not work in practice. To get a balance bill lowered, you must first dispute the charges. Then, you must line up witnesses to testify at trial. You may need to bring your medical records to show that you were properly treated. This can be difficult, especially if you do not want the medical records to be published.
In addition to surprise billing, the federal government has passed legislation that restricts insurers from charging out-of-network providers. This act also prohibits nonparticipating providers from billing enrollees for non-emergency or emergency services. Also, nonparticipating providers must disclose the federal balance billing protections to consumers to avoid surprises. However, if you are already aware of the law, you should be able to avoid balance billing in your own life.
