If you’ve received unexpected medical bills, you might be eligible for a balance billing lawsuit. In this article, we discuss what this lawsuit involves, what you need to do to file a balance billing lawsuit, and what the judge in the Balance Billing case decided. This article also discusses the No Surprises Act and Dr. Martello. And, of course, we’ll touch on Dr. Martello’s case as well.
Out-of-network providers
Often, health care insurance policies will cover care from in-network providers, but they won’t pay the full amount if an out-of-network provider bills above the patient’s cost-sharing liability. When this happens, patients are often left with a huge bill from an out-of-network group that they’re not familiar with. In such cases, patients may be entitled to compensation.
The legal right to balance bill your insurance plan requires that an out-of-network provider have your written consent before charging you a balance. By providing this written consent, out-of-network providers are not allowed to charge you more than your insurance plan co-payments. Also, “fully insured” coverage does not mean out-of-network protections are available. Patients often receive surprise bills, when the participating doctor was unavailable or provided services without the patient’s knowledge.
While health insurance rates for working-age Americans have steadily improved over the past decade, not everyone with health insurance is protected. One-fourth of insured Americans have significant gaps in coverage and high out-of-pocket expenses. Even with coverage, all consumers are still susceptible to surprise medical bills. Balance bills occur when an insurer covers a provider but charges the consumer for out-of-network services. In such situations, the consumer has no control over the circumstances surrounding these bills.
Dr. Martello
A recent judgment in Dr. Martello vs. Balance Billing’s lawsuit has led to a new round of litigation in the California medical field. The lawsuit was brought by the Medical Board of California against Dr. Martello, a licensed physician in Los Angeles. The California Medical Board charged Martello with unprofessional conduct and alleged that she had improperly balanced billed patients. Among other things, she was found guilty of dunking patients for their balances and requiring them to sign contracts agreeing to pay the balance. The case is currently pending appeal.
The Department of Managed Healthcare in California filed a cease-and-desist order against Dr. Martello in December 2010. After this, the board sued Dr. Martello in state court in Los Angeles County. On May 15, 2012, Los Angeles Superior Court Judge David Milton issued a preliminary injunction against the doctor. The ruling was subsequently made permanent on November 15, 2012. This has led to the suspension of all balance-billing lawsuits by Dr. Martello, as well as all the other ones he has filed against patients who received emergency care.
Los Angeles judge
A Los Angeles judge has denied the plaintiff’s request for a stay in his balance billing case. Balance billing is a practice that occurs when an insured person visits a doctor who is not part of his or her preferred network. Because the insurance company reimburses out-of-network doctors at lower rates than in-network providers, the health care provider is left to bill the patient for the difference. This practice has been called unfair and evasive, but the Los Angeles judge’s ruling may change that.
Martello, a plastic surgeon in South Pasadena, was convicted by a Los Angeles judge of illegally billing insured patients. The doctor, Jeannette Martello, balance billed multiple patients at two hospitals – Huntington Memorial Hospital in Pasadena and Providence St. Joseph Medical Center in Burbank. In the case, the Los Angeles judge ordered the doctor to spend five days in jail and drop all legal actions against the patients who she billed illegally.
No Surprises Act
The No Surprises Act is a federal health law that restricts doctors from overcharging their patients. The government tries to prevent doctors from overcharging their patients by limiting their access to certain types of healthcare. However, the lawsuit is not without precedent. In 2016, the Association of American Physicians and Surgeons filed a similar lawsuit against California’s surprise billing law. But the lawsuit was dismissed by a federal court this year.
Since then, eight lawsuits have been filed against the law. All of them challenge the No Surprises Act’s interim final rule regarding the use of independent dispute resolution. The lawsuits take issue with the requirement that an independent dispute resolution entity presumes that a patient will be paid the same amount as an insurer’s in-network rate. Nevertheless, the law still allows doctors to use independent dispute resolution if they cannot settle.
