ALBUQUERQUE, N.M. (Legal Newsline) – An aero-medical transportation service is seeking declaratory judgment regarding billing for its services.
PHI Air Medical LLC filed a complaint on April 24 in the U.S. District Court for the District of New Mexico against New Mexico Office of Superintendent of Insurance, et al. seeking declaratory relief.
According to the complaint, the plaintiff provided service to two New Mexico residents insured by New Mexico Health Connections (NMHC). The plaintiff alleges it billed NMHC for more than $40,000 each, and New Mexico Health Connections reimbursed the plaintiff 33 percent of each bill.
The plaintiff alleges it appealed this reimbursement, which was denied, and the patients submitted grievances to New Mexico Office of Superintendent of Insurance. The suit states it was ruled that PHI could not balance bill the patients.
"PHI agrees with the patients that NMHC is obligated to pay the balance of the bills in each case. However, the insurance laws do not prohibit PHI from balance billing a patient if a managed health care plan refuses to pay PHI’s usual, customary and reasonable charge for out-of-network emergency Transportation Services. The OSI defendants are misinterpreting the insurance laws and are enforcing them to prohibit PHI’s ability to balance bill in violation of the preemption provision of the federal Airline Deregulation Act.
"Accordingly, PHI seeks declaratory relief from this court holding that the insurance laws do not prohibit PHI’s ability to balance bill when PHI provides out-of-network emergency transportation services, as they are preempted by the ADA," the suit states.
The plaintiff seeks declaratory judgment against defendants and other relief to which it may be entitled. It is represented by David W. Bunting of Rodey, Dickason, Sloan, Akin & Robb PA in Albuquerque, New Mexico.
U.S. District Court for the District of New Mexico case number 1:18-cv-382