Two North Texas free-standing emergency room operators want tech giant Google to give up the identities of nearly two dozen reviewers who rated them poorly online.

Highland Park Emergency Center on Lemmon Avenue and Preston Hollow Emergency Room on Walnut Hill Lane filed a joint petition Tuesday in Dallas County District Court.

The 30-page pre-suit deposition lists the screen names used by 22 individuals, who the facilities claim never were treated in their emergency centers.

They want Google to share the users' identities and the review site's metadata in order to help with the investigation. Google could not immediately be reached for comment.

The petition was filed by Scott Yackey, a Dallas-based associate in the intellectual property group of the law firm Dykema Cox Smith. The firm has been contacted for more information.

Like other businesses, health care providers across the U.S. have been struggling to figure out how to manage online reviews.

It’s a particular challenge for the medical industry, as consumers often have little detail about costs or quality of care beforehand. Moreover, patients tend to enter the system under high-stress situations.

With more consumers turning to the web to seek out information about their doctors and medical facilities, health care businesses are more frequently having to address negative reviews posted on sites such as Facebook, RateMD, Healthgrades and Yelp.

Some have proactively set up their own websites to solicit patient feedback, while others respond to claims posted on existing sites. Some use the information to improve the patient experience.

And there are health care organizations that encourage as many patients as possible to share comments. It's sort of a numbers game, said Alicia Daugherty, who leads a team that researches market innovation, patient engagement and transparency for the Advisory Board.

"If they can make it easy for more patients to leave reviews, then their overall average tends to go up and the impact of negative reviews is less," she explained.

Very few have turned to lawsuits. But they are starting to appear.

For example, in September, an Ohio plastic surgeon filed a defamation lawsuit against a Chicago woman who posted anonymous reviews on websites used by patients to swap information about doctors.

The woman claimed her problems got worse after surgery, but the surgeon claimed the reviews were "rife with false information," reported The Wall Street Journal.

Generally speaking, health care consultants say there are pros and cons to going the legal route.

One benefit is that it could deter fraudulent activity. The risks are that exposure might make it more widely known that an organization has negative reviews, or make patients uncomfortable.

"It’s difficult for businesses to actually know what happened if they don't have a real name," Daugherty said. "But in health care, people don’t want everyone to know what kinds of services they are receiving. There are patient privacy issues."

In the petition filed Tuesday in the Dallas County court, Highland Park Emergency Center and Preston Hollow Emergency Room argued that Google reviewers who were never patients, or the guardians of patients, gave them one-star ratings and posted angry comments.

The reviews were probably posted by a third party “to defame and disparage” their businesses, they said.

In one example, a person wrote that although the care they received was timely and cordial, they were left with an $8,000 bill. In another, a reviewer referred to the business model as "extremely deceiving" and said patients get charged "an exorbitant amount of money" for simple procedures. "Scam, scam, scam," wrote another.

The emergency rooms said that their review of internal medical records did not identify patients with the names listed online. According to the petition, the facilities believe the reviewers were contracted or hired by a competitor in order to intentionally and fraudulently post false reviews to damage their reputations.

The ER operators said they often responded back, acknowledging the complaint, providing contact for billing, or asking the reviewer to confirm they have the correct facility.

That tends to be a good approach, said executives at the Binary Fountain, a Virginia-based group that helps health care organizations with patient experience and reputation management.

However, when it comes to negative reviews, the group has a "take it for what it is" philosophy, said executive vice president of strategy and corporate development Andrew Rainey.

Tracking down anonymous online identities is time-consuming and difficult, and the opposite direction of where health care is trending.

"I understand where they’re coming from. Online reviews do impact volume and perception," added senior vice president of marketing, Aaron Clifford. The challenge health care facilities have is getting more happy consumers to speak up.

"It’s incumbent on the system to provide a good enough experience to the patient to that they'll want to."

While it remains to be seen how the request will play out, the concerns with free-standing emergency rooms has been in the public spotlight for some time.

It’s a relatively new health care model, one that has been growing rapidly in Texas. But the facilities' out-of-network status with health insurers quickly led to consumer complaints.

And not just online.

For example, in January, a Colorado man filed a lawsuit against the largest operator of free-standing emergency rooms, Lewisville-based Adeptus Health. The lawsuit claimed the company misled patients who could have been treated in lower-cost urgent care centers.

That case was halted in June, a few months after Adeptus filed for bankruptcy. It emerged from Chapter 11 last month when its debt was taken over by a New York hedge fund.