A recent court decision has sparked significant debate over the transparency of hospital billing practices, particularly concerning emergency services fees. On July 1, 2024, Farzam Salami filed a complaint against Los Robles Regional Medical Center in the California Court of Appeal, Second Appellate District, Division Six. The case revolves around Salami's accusations that Los Robles charged him undisclosed emergency services fees (EMS fees) without his agreement.
The dispute began on August 8, 2020, when Salami received emergency medical treatment at Los Robles. Before receiving care, he signed a conditions of admission contract (COA), agreeing to pay for services "actually rendered" as listed in the hospital's chargemaster. However, Salami was billed $31,565.90 for the services provided, which included a "Level 5" EMS fee of $5,923.25. This fee was part of the chargemaster but not explicitly disclosed to Salami beforehand. Although his bill was later discounted to $3,156.59 and he paid a portion of it, he did not settle the entire amount.
Salami returned to Los Robles for emergency services on October 5 and December 25, 2020, and was again charged EMS fees each time. He claims that had he known about these charges in advance, he would have sought less expensive treatment elsewhere. In December 2021, Salami sued Los Robles for breach of contract and declaratory relief on grounds that the EMS fees were not for services "actually rendered" but rather covered general operating costs.
Los Robles responded with demurrers to both Salami's first amended complaint (FAC) and third amended complaint (TAC). The trial court sustained these demurrers without granting leave to amend. It ruled that Salami's FAC failed to state a breach of contract claim because it did not allege that he had substantially performed his part by paying for services rendered or that he was excused from doing so. Additionally, the court found that Los Robles had substantially performed its duties by providing emergency services.
In his TAC, Salami introduced claims under the Unfair Competition Law (UCL) and Consumers Legal Remedies Act (CLRA), arguing that Los Robles had a duty to disclose its intent to charge an EMS fee before treating patients in the emergency room. However, citing cases like Saini v. Sutter Health and Gray v. Dignity Health among others, the trial court concluded that no such duty existed under current laws and regulations.
Salami argued that hospitals should be required to provide additional signage or warnings about EMS fees beyond listing them in their chargemasters. However, courts have generally held that hospitals fulfill their transparency obligations by making their chargemasters available as required by law.
Ultimately, the appellate court affirmed the trial court’s judgment in favor of Los Robles Regional Medical Center. The court reasoned that existing state and federal regulations do not mandate additional disclosures about EMS fees beyond what is included in chargemasters.
Representing Farzam Salami were attorneys from Carpenter Law and Barry L. Kramer from the Law Office of Barry Kramer. King & Spalding attorneys Glenn Solomon, Paul R. Johnson, Amanda L. Hayes-Kibreab and Ariana E. Fuller represented Los Robles Regional Medical Center before Judges Baltodano, Yegan, Cody and Superior Court Judge Matthew P Guasco under Case ID No B3827348.