APP of New Mexico, Lovelace Health System Sued Over Alleged Overbilling Practice

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A proposed class action alleges APP of New Mexico ED, PLLC and Lovelace Health System, LLC have “systematically overbilled” patients for medical services, “often by hundreds of dollars per visit.” According to the case, APP has improperly billed patients at an out-of-network rate despite Lovelace’s representations that the hospital system is an in-network provider under patients’ insurance plans.

The case explains that APP of New Mexico provides emergency room staffing for a system of healthcare facilities that includes seven hospitals, 26 clinics, and five emergency rooms operated by Lovelace. As part of APP’s business agreement with Lovelace and its contracts with insurance companies, the staffing unit agrees to accept reimbursement for medical services at in-network rates in situations when Lovelace is an in-network provider under a patient’s insurance plan, the lawsuit states. Patients are billed separately by APP and Lovelace for services, even if those services are provided during same emergency room visit, the case adds.

Despite APP’s agreement and Lovelace’s representations to the public that it is an in-network provider under “numerous” insurance plans, patients often discover that they’ve been billed by APP at out-of-network rates, the case alleges. According to the complaint, patients are not informed before being treated at a Lovelace healthcare facility that some or all of their treatment may be provided by APP employees, nor that they may be billed at out-of-network rates despite Lovelace’s status as an in-network provider under their insurance plans. As the lawsuit tells it, APP and Lovelace are part of a joint enterprise for the purposes of providing emergency room services and sharing profits.

The four named plaintiffs claim they each received medical services at a Lovelace facility and were then billed by APP at an out-of-network rate. The plaintiffs were allegedly reimbursed by their respective insurance companies at in-network rates, which left the individuals to pay hundreds of dollars to APP that the lawsuit claims the company was not entitled to.

The plaintiffs allege that both APP and Lovelace are complicit in and benefit from the “overbilling transaction,” which is labeled in the suit as an “unfair and deceptive” trade practice.

The case seeks to cover New Mexico residents who, within the past four years, received medical services at a Lovelace facility and were billed by APP “for amounts greater than the in-network amount permitted by their insurance provider.”