Medical Billing Case Goes to Indiana Supreme Court

The Associated Press has an article about a case I flagged last October that has moved up to the Indiana Supreme Court and is set for oral argument May 10th.

I’m not sure the AP write-up does its readers many favors. It says, simply, the lawsuit “accuses the state‚Äôs largest hospital group of charging uninsured patients more for treatment than insured patients.”

Procedurally, I think the case is still at a very early stage – I don’t think the Supreme Court is at all being asked to decide whether hospitals can charge uninsured patients more than insured ones. The trial court dismissed the Plaintiffs’ complaint for failing to state a claim. The Court of Appeals reversed that decision. The Supreme Court has agreed to review the Court of Appeals decision. So, I think we’re still trying to figure out whether the Plaintiffs can even maintain a lawsuit.

The Plaintiffs want a court to declare what they actually owe the hospital. The hospital wants to say they owe whatever came out on the bill. The Plaintiffs are probably arguing for a more ambiguous “reasonable” amount. If the Supreme Court agrees that it’s appropriate for a patient to go to court seeking a declaration of the actual amount of the bill, the Plaintiff will then have to show the “reasonable” amount of the service is different from the amount charged. Plaintiffs are also seeking to maintain a class action which strikes me as some pretty tough sledding — the core of these kinds of cases is going to be trying to determine what the reasonable cost of the service is; and that’s a very individualized question, one that doesn’t lend itself to class treatment very well.

Finally, I have to think these plaintiff’s attorneys are going to have to figure out an angle that gets their attorney’s fees paid. The uninsured aren’t likely to have a lot of cash for paying lawyers, and a declaration that you owe less than the billed amount doesn’t provide an obvious stream of cash for paying lawyers.

Comments

  1. Johnny from Badger Grove says

    I thought all hospitals, indeed all providers, charged the uninsured more?

    My GF had a cardiac procedure done a few years ago. The “cash price” was around $72,000. They “settled” with the insurance company for $27,000. The pretty poor dental insurance at work would pay the dentist $600 for a full crown. MY price? about a Big Mac less than a cool thousand.
    Maybe there should be an action class.

  2. Carlito Brigante says

    Different payors pay different prices for services.

    The hospital’s chargemaster is proprietary and confidential information. Many hospitals by the pricing information from date companies to insure they charge what other comparable and area hospitals charge. Many hospitals have not clue what their real costs are. (The beauty of being tax-exempt.)

    Similarly, payors purchase reimbursement information from data companies and this information is similarly proprietary and confidential information.

    Small indemnity insurance companies reimburse the lesser of charges or R &C (reasonable and customary (and maybe another adjective).

    Medicare and Medicaid also pay off of fee schedules.

    The uninsured are at the mercy of the hospital chargemaster. People with indemnity insurance are at the risk of the R&C that the provider will pay and the provider’s decision to balance bill up to the charged amount.

    I find the Republican fascination with medical savings accounts and “consumer-driven” healthcare laughable and disingenous. Patients have no bargaining power against providers and usually do not even have pricing information. Most of their care is not “consumer” driven (elective), but emergency or physician recommended.

    MSAs have a very cursory appeal and did have at their genesis the recognition of a consumer’s lack of bargaining power. But they cannot create bargaining power for consumers. That is their fatal flaw.

  3. Mary says

    Isn’t this why (referring to an earlier convo) it is unrealistic to ask a doctor how much a procedure will cost. He/she would be able to give you a going rate, but without your insurance’s proprietary data and the hospital’s secret files, it’s hard for the doc to know what part of his/her charges will be covered and impossible to know the other providers’ charges.

  4. Amy says

    I had an argument with someone about that sometime. They didn’t believe me when I told them that uninsured people pay more than the insurance company. I told her to look at her next EOB and see the “discount” that the insurance company gets. It’s totally true.

    That being said, those doctor’s offices and hospitals are no dummies. If you have cash and make an offer, they’ll work with you. Our pediatrician’s office always gave us a discount when I would take the kids for well child visits when they weren’t covered – but I had to ask for it. Otherwise, I got billed the full amount. And I had to ask at the doctor’s office, once it went to billing those people couldn’t help at all.

  5. Knowledge is Power says

    Bottom line: Court of App. decision is now null, at least for the time being. Some/all members of the Supreme Ct have some policy matters that they want to publish.

    Wonder if they will get their decision written before Justice Sullivan has officially retired and the replacement has been seated?

  6. Al says

    Given my experiences every time I have surgery or a procedure, they probably just reached the end of their rope as the bills kept trickling in for a one-time event. How can you know up front what it costs when you can’t even tell what exactly you paid afterwards? It’s like they’re not expecting you to question them when you get bills weeks after the fact from doctors you’ve never seen or even heard of

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