San Diego

Lawsuit: Rural Metro Charged Medi-Cal and Medicare Patients for Ambulance

Class action lawsuit accuses ambulance provider of "balance billing"

A newly filed class-action lawsuit alleges San Diego’s ambulance provider, Rural Metro, is billing patients who are covered by Medi-Cal and Medicare.

Phillip Franklin filed the lawsuit in Federal Court on June 1.

Franklin says he called 911 on August 3, 2017 after experiencing side effects from a prescription medicine. When the ambulance arrived, Franklin showed the medics his insurance cards. A Rural Metro ambulance then transported Franklin to UC San Diego Hospital in La Jolla.

A month and a half later, on September 20, Franklin received a bill in the mail.

The invoiced showed the ride cost $2,340. Franklin’s Medicare and Medi-Cal plans, also known as MediConnect, paid a total of $444.28 after adjustments had been made. That left, according to a bill from Rural Metro, with a $113.34 balance.

"I looked at the bill and I said, ‘Wait a minute, I’m insured," Franklin told NBC 7 Responds during an interview.

"I know they got their money because I could see from my insurance records that they got paid.”

Franklin said he called Rural Metro’s customer service center to resolve what he assumed was a simple error.

"I called them to tell them, ‘Hey, you made a mistake here. Let’s wrap this up because I don’t want to get any more of these bills."

He says Rural Metro’s customer service center, however, refused to budge. Rural Metro then sent the balance to collections.

Franklin said he began to do research and found stories from NBC 7 Responds where patients were sent to collections for bills that were never sent to their insurance providers. In those cases, Rural Metro cleared the debts for more than one hundred customers. 

But Franklin’s problem was different and he says he felt his options were limited.

"A hundred dollars is a lot to me," Franklin said. "Plus, I knew it wasn’t fair and if I didn’t do it then who was going to do it?"

The lawsuit claims Rural Metro practices what is known as “balance billing.”

"Balance billing occurs when a patient’s health insurance provider pays for a portion of a medical bill and the healthcare provider bills the patient for the remaining balance," reads the proposed class action lawsuit.

According to the lawsuit, charging customers who are enrolled in Medi-Cal and Medicare is illegal under California and federal law.

The lawsuit cited NBC 7’s previous coverage of the issue.

"In August 2016, NBC San Diego published a story in which three San Diego families complained that they had received collection notices from Defendant Credence to collect debts purportedly owed to Defendant Rural/Metro for ambulance services. The families had never received bills from Defendant Rural/Metro. Defendant Rural/Metro blamed the issue on a ‘processing change that was made when Rural Metro came out of bankruptcy and that it had identified and corrected the issue.’"

In a statement, a spokesperson for Rural Metro stated, "We want the public to know that we take all complaints – including lawsuits – in a very serious fashion and will investigate accordingly."

A federal judge is expected to rule on class certification in the coming year.

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