On January 7, 2022, Judge David S. Cunningham III of the Los Angeles Superior Court ruled that our lawsuit against Temecula Valley Emergency Physicians, Inc. survives dismissal against their legal challenges.
Our lawsuit alleges that Temecula Valley Emergency Physicians, Inc. routinely engages in unlawful debt collection practices and unlawful “balance billing”. A copy of our Complaint can be viewed by clicking HERE.
This lawsuit is based on the allegations that Temecula Valley knowingly performs emergency room medical services by independent medical professionals who are “outside” of the patients’ pre-approved insurance network (even though the rest of Temecula Valley Hospital itself is within the approved insurance network), knowing fully well that the services performed by the independent medical professionals will not be covered by insurance, so that Temecula Valley Emergency Physicians, Inc. can then bill the emergency room patients directly out of pocket.
Billing the patients directly allows Temecula Valley Emergency Physicians, Inc. to collect a larger amount than what insurance companies are likely to pay (as insurance companies will usually negotiate to pay a lower amount).
Additionally, billing patients directly is also more likely to result in successful payments without legal fighting, as the medical provider seeking payment would have to decide whether to pursue a costly lawsuit against the recalcitrant insurance companies or pursue collections against the patients who are not likely to be protected by a team of lawyers ready to litigate on command.
This scheme resulted in our client being forced to pay thousands of dollars to Temecula Valley Emergency Physicians, Inc. that should have either been covered by her insurance company, or should have resulted in Temecula Valley seeking legal recourse against the insurance company for refusing to cover the services.
It should go without saying that engaging in a practice of knowingly devising a scheme to rip off emergency room patients at a time when such patients are not capable of providing legally binding consent (due to insufficient mental capacity, lack of consciousness, etc.) is disturbing and shameful, and is deserving of significant damages.
Thankfully, Judge Cunningham denied Temecula Valley Emergency Physicians, Inc.’s request for a dismissal based on the argument that they are not subject to the prohibition on “balance billing” because our client’s insurance provider is not listed on the website showing a list of insurance companies licensed and regulated by the Calif. Department of Managed Health Care. A copy of the Court’s tentative ruling can be viewed by clicking HERE.
Essentially, Temecula Valley Emergency Physicians, Inc. is trying to exploit what they see as a loophole in the prohibition on balance billing. If Temecula Valley Emergency Physicians, Inc.’s argument were to prevail, then nothing would stop every insurance company and every medical provider from changing their business practices in a way that would allow them to also exploit the same purported loophole. Surely,
this would be an unjust and grossly unfair result that would cause millions of emergency room patients to suffer significant financial hardship and would only serve to further degrade and erode the health of our economy and working class (which are already stretched thin to a breaking point by the pandemic).
If you or a loved one is suffering a similar situation, where you are facing emergency room billing collections that your insurance company has refused to pay, please do not hesitate to contact us for a free and confidential consultation to discuss whether your rights have been violated as well.