Title: Granina v. Tarzana Emergency Medical Associates, Inc., Case No. 20STCV39448
Court: Superior Court of the State of California for the County of Los Angeles
Class: All California residents who received emergency medical services at an emergency department of a hospital in California that was in-network to the patient’s health insurance plan by a medical service provider who was out-of-network to the patient’s health insurance plan and was employed, managed by, or contracted with Tarzana Emergency Medical Associates, Inc. (“Tarzana EMA”), EMA Holdings, LP d/b/a Emergent Medical Associates (“Emergent”), and Pacific HealthWorks, LLC (“Pacific HealthWorks”) (collectively, “Defendants”), or an affiliate thereof, and received a balance bill from the provider.
Class Period: Approx. January 1, 2017 to Present
Wolf Popper LLP is counsel for the plaintiff and the proposed class of California residents who received emergency medical services at certain hospitals in California and received a “surprise” or “balance bill” from the provider. Patients across the country are being unconscionably subjected to surprise billing (a/k/a balance billing), which occurs when a patient goes to a hospital that is “in-network” with his/her health insurance, only to find out weeks or months later that the doctors in that “in-network” hospital are “out-of-network” and their services are not covered by the patient’s insurance. Unconstrained by any negotiated agreement, the out-of-network provider’s services are billed at rates in excess of the reasonable fair market value of the services provided. The result can be financially disastrous for consumers who reasonably thought they had nothing to worry about since they had obtained health insurance coverage and went to an in-network facility for treatment.
Disturbingly, surprise billing is especially common in emergency rooms, where patients go when in health crisis or when they cannot otherwise visit their primary care physicians. A physician group that contracts with an in-network hospital behaves egregiously when it does not disclose its independent status or even its name so that consumers may check whether the physician group is in-network to the patient’s insurance, and when it does not disclose that is not within the same insurance network as the hospital and does not make information available about what insurance providers are “in-network.” The problem is compounded when the group then sends surprise bills for charges in excess of the fair market value of the services provided.
According to her complaint, Plaintiff’s daughter received emergency medical services at an emergency department (“ED”) in January 2020, where she was attended to by a Tarzana EMA physician staffed by defendants Emergent and Pacific HealthWorks. Plaintiff had known the Tarzana Medical Center to be in-network to her health insurance plan and intended that her daughter be treated at their ED accordingly. Plaintiff had no prior knowledge, nor was it clearly disclosed to her during her daughter’s visit, that the attending physicians in the ED were not affiliated with the Tarzana Medical Center and were out-of-network providers to her health insurance plan. Given that the names of the ED physicians or physician groups were not identified to Plaintiff, she had no way to reasonably ascertain this information on her own in advance of her daughter receiving medical services.
Plaintiff subsequently received a surprise medical bill, payable by check to an unknown Tarzana EMA, or via online payment to an unfamiliar Pacific HealthWorks, charging her for out-of-network emergency services provided for her daughter in the amount of nearly $900.00.
Plaintiff and the members of the proposed class allege that they have suffered injury due to Defendants’ conduct and seek monetary damages, injunctive and/or other equitable relief, declaratory relief, restitution and/or disgorgement of profits.
For further information about this case, contact:
Chet B. Waldman