cupofjojo

Sued for Hospital Bill by JDB in California

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Best of luck to you, but wanted to toss this out there....

Don't be surprised if the person who is the head of collections for the hospital shows up as a witness!  I was sued by a collection agency ($600, can you believe it).  It was NOT a JDB, but tactics were similar.   In discovery, I asked to see a breakdown of specific charges.  They sent it.  There was a charge for a procedure, to this day, I know they did not perform.  Me:  I don't owe this, let's go to court!

The attorney, from 125 miles away AND the head of collections from the hospital showed up.  I knew immediately when the 'small claims' judge welcomed, and said hello to the head of collections 'witness,' I was sunk.

In the end, it turned into an "I did NOT receive this procedure, but am being billed for it," and the judge replying (I swear), "Well, you could have still been coming off the effects of anethesia, and may not remember."  No, your honor, I was wide awake.

Bottomline, I quickly saw the head of collections for the hospital was already very familiar with the judge, and the judge simply sided with her, period.  It's small claims.  The judge had vast leeway.  I knew I had already lost by the way the judge greeted her ...... "Mrs. So And So, nice to see you again. How's the family."  Really?!!

I hope your situation is different.

Good luck!

Jimmy

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Guest usctrojanalum
On ‎1‎/‎13‎/‎2017 at 6:01 PM, calawyer said:

Were the initial charges incurred for emergency medical care?  Did you have  insurance which paid a portion of the bill and you are now being charged for the "balance" (by "balance", I do not mean the deductible but rather a portion of the bill that the hospital claims the insurance company did not pay).  If so, the charge from the hospital may constitute  unlawful "balance billing". 

 

Here is a California Supreme Court case discussing balance billing:  http://caselaw.findlaw.com/ca-supreme-court/1001051.html 

Here is an excerpt:

we conclude that billing disputes over emergency medical care must be resolved solely between the emergency room doctors, who are entitled to a reasonable payment for their services, and the HMO, which is obligated to make that payment. A patient who is a member of an HMO may not be injected into the dispute. Emergency room doctors may not bill the patient for the disputed amount.

This is pretty amazing. 

I wonder how the medical providers get over the issue of standing though if they want to litigate such disputes, guess they would need to take assignments from patients?

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3 hours ago, usctrojanalum said:

I wonder how the medical providers get over the issue of standing though if they want to litigate such disputes, guess they would need to take assignments from patients?

The way they get over the issue is they stop being contracted providers.  This case is from 2009 and this used to be a major problem.  Patients have insurance and they are in a car accident or having a heart attack and emergency responders take them to the nearest medical facility.  The hospital itself is on their plan but the contracted physicians in the ER and/or radiology, the lab etc. are not contracted providers.  Legally the provider not being under contract could balance bill the patient prior to cases like this because the physicians are not a party to the contract for care under the plan.  However, the ethical and moral dilemma is that during a true medical emergency the patient does not have the ability or forethought to question the providers if they are members of the plan.  Even so, in a true medical emergency you are only able to use the providers under contract at the facility you are at nor shop around for a facility with contracted providers that are on the plan.

As a result many states have passed laws requiring that insurance plans cover true emergency medical care as "in network" if the patient went to a contracted facility but the providers are not on the plan.  Many insurance plans have also started providing this coverage on their own.   This issue of the insurance not covering the care for the out of network physicians in the ER is not the problem it USED to be.

What is important to remember is that if the provider is not in network for non-emergency care legally they can bill for the balance that insurance does not pay because they are not a contracted provider and it is NOT balance billing that violates the law.

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Were the initial charges incurred for emergency medical care?  Did you have  insurance which paid a portion of the bill and you are now being charged for the "balance" (by "balance", I do not mean the deductible but rather a portion of the bill that the hospital claims the insurance company did not pay).  If so, the charge from the hospital may constitute  unlawful "balance billing". 

 

Yes, it was an ER visit.  Total bill was $71,800.  My insurance paid 70k of it and they are suing me for rest.  Should I bring this up now to the other side's attorney, wait for court to include it in my trial brief, or some sort of motion?  I have a cmc in March.  Thanks for finding that case it could be a lifesaver.

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On 1/16/2017 at 3:21 PM, Jimmy E said:

Best of luck to you, but wanted to toss this out there....

Don't be surprised if the person who is the head of collections for the hospital shows up as a witness!  I was sued by a collection agency ($600, can you believe it).  It was NOT a JDB, but tactics were similar.   In discovery, I asked to see a breakdown of specific charges.  They sent it.  There was a charge for a procedure, to this day, I know they did not perform.  Me:  I don't owe this, let's go to court!

This is what I worry about.  The discovery response I got from them jdb included the transfer of assignment and one section indicated hospitals willingness to provide a witness if case goes to trial.

 

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@cupofjojo, whether or not the head of collections from your hosptial will show up as a witness, I don't know.  It may largely depend on how far that "head" would have to travel -- and how well the judge may know the head of hospital collections.  In my puny case, the court is less than 10 minutes away from the hospital in Little Rock.  Had I lived, say 100 miles away, I don't think she would have shown.  It also didn't help my case when the judge greeted the woman from the hospital like they had just vacationed together!

In my case, it just happened to be very close by.

Second, and forgive me as I've not looked at your entire thread, but the 'collection agency' was NOT a JDB, but instead an attorney/collection agency rolled into one.  It may help if the debt was actually purchased by a JDB, rather than 'assigned' for collection by the hospital.

Jimmy

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15 hours ago, Jimmy E said:

@cupofjojo, whether or not the head of collections from your hosptial will show up as a witness, I don't know.  It may largely depend on how far that "head" would have to travel -- and how well the judge may know the head of hospital collections.  In my puny case, the court is less than 10 minutes away from the hospital in Little Rock.  Had I lived, say 100 miles away, I don't think she would have shown.  It also didn't help my case when the judge greeted the woman from the hospital like they had just vacationed together!

In my case, it just happened to be very close by.

Second, and forgive me as I've not looked at your entire thread, but the 'collection agency' was NOT a JDB, but instead an attorney/collection agency rolled into one.  It may help if the debt was actually purchased by a JDB, rather than 'assigned' for collection by the hospital.

Jimmy

Thank you, Jimmy.  I remember your case well.

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On ‎1‎/‎30‎/‎2017 at 9:38 PM, cupofjojo said:

Were the initial charges incurred for emergency medical care?  Did you have  insurance which paid a portion of the bill and you are now being charged for the "balance" (by "balance", I do not mean the deductible but rather a portion of the bill that the hospital claims the insurance company did not pay).  If so, the charge from the hospital may constitute  unlawful "balance billing". 

 

Yes, it was an ER visit.  Total bill was $71,800.  My insurance paid 70k of it and they are suing me for rest.  Should I bring this up now to the other side's attorney, wait for court to include it in my trial brief, or some sort of motion?  I have a cmc in March.  Thanks for finding that case it could be a lifesaver.

 

Is the remainder your deductible or co-pay?  If not, it may very well be unlawful balance billing.

 

If I were you, I would call the California Department of Managed care.  It has issued cease and desist orders against hospitals/Doctors who engage in "balance billing" and will at least confirm for you that your particular situation qualifies as such.  https://www.dmhc.ca.gov/Portals/0/AbouttheDMHC/NewsRoom/pr010714.pdf

If you receive such confirmation, I would bring it up in your CMC statement and tell the Court (what you are really doing is informing plaintiff) that this case is dead in the water.  If you give me enough lead time, I will help you draft something up.  Not sure you really need to, but you might consider moving to amend your answer to allege a new affirmative defense saying that the underlying charges were for emergency care and the attempt to collect constitutes unlawful balance billing.  You could also ask the court for permission to file a cross-complaint for a Rosenthal Act violation for attempting to collect a debt that is not owed.  Of course then you would be in for a substantial amount of additional work.

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10 hours ago, calawyer said:

 

Is the remainder your deductible or co-pay?  If not, it may very well be unlawful balance billing.

 

Not sure if deductible or co-pay.  It was few yrs back and a different insurance than I have now.  Called them & was on hold for nearly an hr so I hung up.   

I can't tell from the discovery docs received either as hospital provides itemized services but 1 lump sum payment from cigna at end without explanation that a deductible or co-pay is due.  Bill just says remaining balance.

Not sure if I should introduce this at cmc as lawyer may then have more time to use discovery to find out if remaining is deductible I owe or unlawful balance billing I don't.  If I introduce in trial brief he would have less time to figure out whether I owe or not.  Not sure if this makes sense.  I mean it is their case to prove I owe the debt.

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I've read the case law on this in California, highly unlikely that they paid 70k and the 1,800.00 remainder is a balance bill.  Those disputes almost always arise between an insurance company that is out of network with the medical provider (and from what you have described, it sounds like Cigna was in network) . The medical provider bills for a fee of X, and insurance company pays them Y. Then there is a dispute between medical provider and insurance company over the difference between X and Y. Doesn't sound like that is the case here.   

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2 hours ago, usctrojanalum said:

I've read the case law on this in California, highly unlikely that they paid 70k and the 1,800.00 remainder is a balance bill.  Those disputes almost always arise between an insurance company that is out of network with the medical provider (and from what you have described, it sounds like Cigna was in network) . The medical provider bills for a fee of X, and insurance company pays them Y. Then there is a dispute between medical provider and insurance company over the difference between X and Y. Doesn't sound like that is the case here.   

We simply don't know.  If you look at the actual cease and desist order I linked above, the patient stories are very similar.  We don't know the total bill, but the amounts claimed to be owing are very small.  I have seen unlawful balance billing in an emergency situation where the insurer finally agreed to pay IN network rates.  That is because, under California law, the hospital is entitled to recover the reasonable value of services rendered.  The reasonable value might exceed even the in-network rate of any given insurer.

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6 hours ago, cupofjojo said:

Not sure if deductible or co-pay.  It was few yrs back and a different insurance than I have now.  Called them & was on hold for nearly an hr so I hung up.   

Call back and request a copy of all the EOB:  Estimation of Benefits for the care related to that visit.   You NEED THEM.

6 hours ago, cupofjojo said:

I mean it is their case to prove I owe the debt.

They do have proof you have a debt.  If you have an affirmative defense such as illegal balance billing that burden is on you. 

2 hours ago, usctrojanalum said:

I've read the case law on this in California, highly unlikely that they paid 70k and the 1,800.00 remainder is a balance bill.  Those disputes almost always arise between an insurance company that is out of network with the medical provider (and from what you have described, it sounds like Cigna was in network) . The medical provider bills for a fee of X, and insurance company pays them Y. Then there is a dispute between medical provider and insurance company over the difference between X and Y. Doesn't sound like that is the case here.   

Balance billing does not automatically mean ILLEGAL balance billing.   I have been saying this all along but there are a few posters who seem to believe that ANY balance billing is illegal.

If the patient gets care and the provider bills $72000 and the insurance pays $70000 and the carrier EOB states the patient responsibility is $2000 then the provider can legally bill the patient for the $2000 balance.  It is NOT illegal balance billing. 

If the carrier bills $72000 and the carrier pays $70000 and states the patient responsibility is ZERO then if the provider bills for the $2000 balance THAT is illegal balance billing.

The OP needs to get their EOBs from the carrier.   If this is their contractual responsibility then settling it before trial may be better.   If this is illegal balance billing then there is an affirmative defense to the suit.

 

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So I sent out Disc-015 per ccp 96.  I received 2 ccp 98's from attorney: one for someone from the jdb (no address was provided for service) and the second from a hospital billing employee (address for service is a PO Box).   Once I am within the timeframe to issue subpoenas how should I do so?  The first one has no address and the second one is a po box.  Should I try to motion in limine to disqualify the ccp 98's instead of serving a po box.  I assumed a physical address was needed.  Any help is appreciated.

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Do they say that you can serve the lawyer for Plaintiff with a subpoena for the witness?

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2 hours ago, calawyer said:

Do they say that you can serve the lawyer for Plaintiff with a subpoena for the witness?

No. First one has the attorney's address in the header but no where in the ccp98 is there an address or stating where they can be served.  Hospital employees ccp 98 states she can be served at po box.

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I think I would send a letter.  That way, when they ignore it, you will be able to say that you even wrote to them, pointed out the "mistake" and they did nothing to remedy the deficiency.  It will help a bit with the motion to preclude.  Something like this:

[Plaintiff] v. [Defendant]  ______County Superior Court Case number________

Dear ______

 

I write concerning the Declarations of _____ and _____ served in the above action purportedly pursuant to CCP 98.  Neither Declaration complies with that section as neither provides "a current address of the affiant" .  As you are aware, CCP 98 requires that an address be provided  "that is within 150 miles of the place of trial"   so that Defendant may serve a subpoena to attend trial on the witness.

 

Please be advised that Defendant will object to any attempt to use either of these Declarations at trial.

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So, I sent letter to opposing counsel.   His response was basically stating subpoena can be served at his office for jdb declarant & same po box listed on ccp 98 for hospital employee.  Should I just lay low and submit MIL to preclude without issuing subpoenas since ccp 98 is flawed or issue subpoenas and do MIL to preclude. The reason i'm wary of issuing subpoenas is that hospital is literally across the street from court so witness could easily show.  Not sure if better strategy is to get ccp 98 tossed on it's flaws without issuing subpoena or with issuing.

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The "belt and suspenders approach" is to attempt to serve the subpoenas on the witness.  However, here, it looks as if the response you received is even worse.  You can't serve a person personally at a PO box.

 

PM me the actually wording of the letter you received.

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calawyer you da man!  Judge looked over the CA Supreme Ct case you cited and said he agrees that my case constitutes balance billing and scolded the jdb for even bringing this case.  Case dismissed and will be filing to recoup my expenses.  Glad I listened to you and a few others on this forum and not the naysayers that automatically assume the hospital is always in the right.  Thank you!!!!!

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On 10/18/2017 at 4:47 PM, cupofjojo said:

calawyer you da man!  Judge looked over the CA Supreme Ct case you cited and said he agrees that my case constitutes balance billing and scolded the jdb for even bringing this case.  Case dismissed and will be filing to recoup my expenses.  Glad I listened to you and a few others on this forum and not the naysayers that automatically assume the hospital is always in the right.  Thank you!!!!!

Another great Cali  win!  Congrats to you and the fine Cali members here and, of course, to the superlawyer, @calawyer

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On ‎10‎/‎18‎/‎2017 at 2:47 PM, cupofjojo said:

calawyer you da man!  Judge looked over the CA Supreme Ct case you cited and said he agrees that my case constitutes balance billing and scolded the jdb for even bringing this case.  Case dismissed and will be filing to recoup my expenses.  Glad I listened to you and a few others on this forum and not the naysayers that automatically assume the hospital is always in the right.  Thank you!!!!!

So happy for you.

 

And so amazed that a Hospital would not be aware of the leading California case on this issue.  Maybe I am naïve.  Maybe they wanted to see if you knew the law.  If so, shame on them.

 

Again, nice going!

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