Medical Transport Court of Appeals Case (California)

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Medical Transport Court of Appeals Case (California)

Postby jpod on Thu Aug 01, 2019 7:31 am

Did anyone see the America Angel case yesterday on the CoA's website? WCC has a brief article on it today.

Why is this not considered capping? Med-mileage is a WC benefit and from the decision it looks like one party collected 20% of the payments. Even if it is transport fees rather than payment calculated on mileage it is still a medical benefit derived from LC 4600.

What am I missing?
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Re: Medical Transport Court of Appeals Case (California)

Postby LawAdvocate on Thu Aug 01, 2019 8:48 am

This was a business relationship between the transportation company, and a billing and collections company.

This is not capping because the billing and collections company were not illegally promoting the business. Billing and collecting companies for services provided on work comp liens/bills can charge what ever they want - 20% is not out of the norm. We know other companies that collect for work comp providers that charge up to 33% of the result. There is nothing illegal about this type of relationship or the fees charged.

The transportation company in this case has alleged their billing and collections company had "mishandled" accounts. That is a pretty high standard to prove in court, especially in something like workers' compensation collections, where the rules are complex and your bills can be dismissed on mere technicalities.

Capping would involve soliciting and paying attorneys, medical providers and/or applicant's to use their transportation service. I saw no evidence of capping in this case.
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Re: Medical Transport Court of Appeals Case (California)

Postby jpod on Fri Aug 02, 2019 8:41 am

This is the sentence in the decision that raised concern: "Plaintiffs provided transportation services to applicants based upon defendant’s requests, typically ranging between 10 to 50 requests per day.

Perhaps I am reading too much into that sentence but on first read I took it to mean that Defendant (bill collector) provided 10 to 50 applicants to the Plaintiff (transport company) a day, not that transport company secured its own clients.

The trial ruling was a summary judgment though so who knows if that sentence could be proven to mean what I took it to mean. But if you assume the sentence means what I thought on initial read doesn't that change your view that this is a typical bill collection service? The service being paid for is more than collection, it includes supplying the clients too.
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Re: Medical Transport Court of Appeals Case (California)

Postby LawAdvocate on Fri Aug 02, 2019 9:21 am

I think you are mixing "defendants" in this matter, as that sentence, in my reading and in context, refers to insurance defendants as this transportation agency was and is on multiple panels.
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Re: Medical Transport Court of Appeals Case (California)

Postby jpod on Fri Aug 02, 2019 9:35 am

The court refers to workers' compensation insurers or third party administrators in the paragraph above so I don't read it that way.

Here is the entire paragraph:

Plaintiffs provided transportation services to applicants based upon
defendant’s requests, typically ranging between 10 to 50 requests per day. Mostly,
transportation would start at an applicant’s home and many would involve trips to
multiple appointments — such as a radiological examination and chiropractic treatment
including a trip to defendant’s medical facilities in Santa Ana. Each trip would be
documented in a “trip sheet” filled out by a driver and later given to plaintiffs, who would
then submit the sheets to defendant. Then a billing service company acting on behalf of
defendant would attach a generic insurance billing form to the sheets and send them to
the appropriate insurers for payments.
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