{¶ 2} Plaintiff-Appellant, Med Flight, Inc. ("Med Flight"), appeals a judgment of thе Crawford County Municipal Court, granting Defendant-Appellee's, Doris Whites, motion for summary judgment. The trial court found that because Med Flight had already received payment for its services from Medicare, its attempts to collect an additional $1,600.00 from Doris constituted balance billing under R.C.
{¶ 3} In December of 2001, Doris' husband, Roland Whites, was a patient at Galion Community Hospital ("Galion Community") as the result of a heart attack. Roland's treating physician at Galion Community ordered Roland to be immediately transported tо Riverside Methodist Hospital ("Riverside Methodist"), which is located in Columbus, Ohio, fifty miles away from Galion Community. The reason for Roland's transfer was that Galion Community could not provide the necessary medical services that he needеd; however, Mansfield General Hospital ("Mansfield General"), in Mansfield Ohio, was only ten miles away from Galion Community and could have provided the necessary medical treatment. The record reflects that Roland's doctоr transferred him to Riverside Methodist rather than Mansfield General based on the doctor's relationship with the cardiology specialist at Riverside Methodist.
{¶ 4} Following the doctor's orders, Med Flight transported Roland to Riverside Methоdist. The next day, Roland died as a result of the heart attack. Both sides agree that Roland's death was not caused by any act or omission on the part of Med Flight.
{¶ 5} The total bill for Med Flight's ambulance services came to $6,000.00. The invоice divided the fee into three parts. The first part was a $4,000.00 basic fee for helicopter transportation. Part two was a charge for $400.00 for 10 miles at $40.00 per mile, representing the cost of transportation from Galiоn Community to the closest qualified medical facility, Mansfield General. The third and final part was a charge for $1,600.00 for 40 miles at $40.00 per mile, representing the additional distance from Galion Community to the medical facility that Roland's dоctor's actually requested he be transferred to, Riverside Methodist.
{¶ 6} Med Flight submitted the entire $6,000.00 bill to Medicare and Roland's supplemental health insurer. Both insurance carriers refused to pay the $1,600.00 additional cost of transpоrtation to Riverside Methodist because Medicare regulations only cover the cost of transportation to the nearest facility capable of furnishing the required level of care. 42 C.F.R. 410.40(e)(1). Therefore, Medicare approved only the flat $4,000.00 helicopter fee and the $400.00 cost of transportation to Mansfield General, which was the nearest facility capable of providing the required medical treatment. This left Med Flight with an unpaid portion of its bill totaling $1,600.00.
{¶ 7} After being denied payment by both Medicare and Roland's supplemental health insurer, Med Flight brought suit against Doris, seeking judgment against her for the balance of $1,600.00 still due on Roland's bill. A stipulation of facts was agreed to by the parties, and both sides filed motions for summary judgment.
{¶ 8} In her summary judgment motion, Doris claimed that Med Flight's attempt to collect more than the Medicare approved amount was balance billing. Med Flight's summary judgment motion argued that its actions were not balance billing because balance billing only refers to seeking additional compensation for covered Medicare services. Additionally, Med Flight contended that Doris was liable for her husbаnd's debts based upon unjust enrichment and the statutory and common law duties of a spouse.
{¶ 9} The trial court found in favor of Doris, ruling that Med Flight's attempt to collect more than the Medicare approved amount was balanсe billing. Accordingly, the case was dismissed. From this judgment Med Flight appeals, presenting two assignments of error for our review.
{¶ 10} Due to the nature of the assignments of error, we will address them out of order.
{¶ 12} An appellate court reviews a summary judgment ordеr de novo. Hillyer v. State Farm Mut. Auto. Ins. Co. (1999),
{¶ 13} R.C.
{¶ 14} Doris contends, and the trial court found, that Med Flight's attempts to collect the $1,600.00 that Medicare refused to pay constitutes balance billing under the Ohio Revised Code. We do not agree with this interpretation of the statute.
{¶ 15} The express terms of the statute define balance billing as involving an attempt to collect a fee that is connected to a "Medicare-covered" service or supply. Here, the $1,600.00 is a charge resulting from services that Medicare did not cover at all. According to the regulations, Medicare only providеs coverage for ambulance services to the nearest hospital that is capable of providing the beneficiary with the required level of care. 42 C.F.R. 410.40(e)(1).
{¶ 16} The nearest hospital that was capable of рroviding Roland with his required level of care was Mansfield General, which was a 10 mile trip from Galion Community. However, Med Flight transferred Roland a distance of 50 miles to Riverside Methodist on the order of Roland's doctor, 40 miles further than the distаnce to Mansfield General. Based on its regulations, Medicare refused to cover the additional 40 miles from Mansfield General to Riverside Methodist and did not pay any of the resulting bill related to the extra expense. The extra 40 miles were not "Medicare-covered" services for which Med Flight is attempting to charge more than Medicare's reimbursement fee. Under the statute, it would have been balance billing had Medicare agreed to cover the extra 40 miles, but had only allowed a reimbursement rate of $100.00 for the trip, and then Med Flight had attempted to collect the additional $1,500.00 from Doris. Because Medicare provided no coverage at all for thе services Med Flight is attempting to collect on, this cannot be balance billing as defined in R.C.
{¶ 17} Doris also argues that the Medicare statutes and regulations themselves prohibit balance billing. Part B of the Medicare act covers supplemental medical insurance benefits, including ambulance services. Sections 1395j-1395w-4, Title 42, U.S. Code; see, also, 42 C.F.R. 410.40. A participating health care provider accepting assignments through Medicare receives reimbursement from the federal government for 80 percent of the covered costs, and the patient is liable for the remaining 20 percent. Section 1395cc(a)(2), Title 42, U.S. Code.
{¶ 18} Section 1395cc(a)(1)(A)(i), Title 42, U.S. Code provides thаt a participating provider shall not "charge, except as provided in paragraph (2), any individual or any other person for items or services for which such individual is entitled to have payment made under this subchaptеr." This typically means that a participating provider may only collect 20 percent of its covered costs from the patient and must accept Medicare's reimbursement schedule. However, as discussed abоve, Roland was not entitled to have any payment made under this subchapter for the additional 40 miles. None of this additional mileage was considered covered services for which there was even a Medicare reimbursement schedule. It was an additional fee that fell outside of the scope of Medicare's coverage.
{¶ 19} Furthermore, Section 1395cc(a)(2)(B), Title 42, U.S. Code, provides that:
Where a provider of services has furnished, аt the request ofsuch individual, items or services which are in excess of or moreexpensive than the items or services with respect to whichpayment may be made under this subchapter, such provider ofservices may also charge such individual or other person for suchmore expensive items or services to the extent that the amountcustomarily charged by it for the items or services furnished atsuch request exceeds the amount customarily charged by it for theitems or services with respect to which payment may be made underthis subchapter.
This paragraph clearly contemplates the exact situation Med Flight is faced with herein. Roland, through his doctor, requested a service in excess of the service for which coverage is provided for under Medicare. Under the above paragrаph, Med Flight is expressly permitted to seek full compensation from Roland for requested services it rendered that exceeded Medicare covered services.
{¶ 20} Based on the above, we find that Med Flight's attempts tо collect the $1,600.00 were not balance billing as defined by the Ohio Revised Code. We also find that Med Flight's actions were not barred by any Medicare statute or regulation. Therefore, Med Flight's second assignment of error is sustained and the judgment of the trial court granting Doris' summary judgment is reversed.
{¶ 22} Having found error prejudicial to the appellant herein, in the particulars assigned and argued, we reverse the judgment of the trial court and remand the matter for further proceedings consistent with this opinion.
Judgment reversed and cause remanded. Shaw, P.J., and Bryant, J., concur.