Helping Californians get the health care they need

Advocacy Notes

Featuring a recent example of HCA Advocates’ compelling work throughout the state.

A consumer sought the help of HCA partner Community Legal Aid SoCal (CLA SoCal) upon receiving an uncovered $61,000 bill for helicopter ambulance transport for her 10-week old infant experiencing seizures. The infant needed emergency transportation from a general trauma center to an in-network children’s hospital across town. The health plan claimed alternative transportation was available, however ground transportation was not available due to social unrest in the community, including blocking of streets and rioting. The health plan denied the claim resulting in a bill to the consumer from the transportation company $61,000. CLA SoCal advocates helped the consumer file a successful appeal to the California Department of Managed Health Care (“DHMC”), in which they filed a brief laying out the applicable clinical criteria and medical necessity standard, and provided evidence of the unavailability of ground transportation. The DMHC agreed and ordered the health plan to pay for the air transport as it was deemed medically necessary, and to send confirmation of payment of the expense within five days. The consumer was extremely relieved that her infant received timely and appropriate services, and grateful to CLA SoCal’s advocates for their services.

Medical billing cases such as these regularly rank in the top three most common problem faced by consumers of the Health Consumer Alliance. Please see our Know Your Rights page, and search the word “bill” to learn more about your rights related to medical billing and call your local Health Consumer Alliance partner if you need assistance.