State suing doctor over billing tactics

When Bill Buck accidentally cut off the tip of his finger at his Duarte cabinet workshop two years ago, he headed to Huntington Memorial Hospital's emergency room.

He assumed his insurance company would sort out the $12,630 bill from the plastic surgeon, Jeannette Martello.

But Martello wasn't satisfied with the $3,500 insurance reimbursement, so she returned the check and filed a lawsuit against Buck, his wife and his business for the full amount, according to the state attorney general's office. She also began a process to force the sale of Buck's home to collect the money, records show.

Martello's use of aggressive tactics to collect fees from emergency room patients like Buck — including lawsuits, taking out liens on their homes and damaging their credit — prompted an unprecedented court case by state health officials and a judge's order for Martello to cease the practices.

The underlying issue is familiar: many physicians don't believe they are getting paid enough for their services. Doctors bill insurance firms and frequently get a fraction of their full fees.

Under managed care plans, out-of-network doctors are supposed to receive the "reasonable and customary" value of the service. "As you can imagine, there is a wide gulf between what the health plans think is reasonable and customary and what the doctor thinks is reasonable and customary," said Carol Lucas, a healthcare attorney not involved in any of Martello's cases.

The state's lawsuit against Martello, however, is the first of its kind, according to Marta Green, California Department of Managed Health Care spokeswoman. State officials allege in court papers that Martello collected or attempted to collect more from patients than insurance companies paid, a practice known as balance billing.

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-- Anna Gorman, Los Angeles Times

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