Cases & Investigations
Tarzana Emergency Medical Associates, Inc. Surprise Bill Litigation

Granina v. Tarzana Emergency Medical Associates, Inc.

Class: All persons residing in the State of California who received emergency medical services at the emergency department of a hospital in California staffed by a physician group managed or controlled by EMA Holdings, L.P. (“EMAH”) or Pacific Healthworks, LLC (“PHW”) between October 15, 2016 through January 1, 2022, and who (1) received a bill issued by or on behalf of an EMAH/PHW-affiliated medical provider who was out-of-network to the Class Member’s health insurance, even though the hospital was in-network to the Class Member’s health insurance, (2) the bill was for the difference between the provider charge (the chargemaster rate) and the portion of the charge paid by the plaintiff’s insurance, and (3) the bill included one or more of the following five CPT codes: 99281, 99282, 99283, 99284 or 99285.
 
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.  Surprise billing (a/k/a balance billing) 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 was 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.

Phone: Chet B. Waldman - (212) 451-9624
Phone: David Nicholas - (212) 451-9642
Phone: Antoinette Adesanya - (212) 451-9635
Phone: Matthew Insley-Pruitt - (212) 451-9621 
Email: outreach@wolfpopper.com
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