Denver, Colorado Denver’s state Supreme Court has ruled. That a Colorado woman is not required to pay thousand dollars of medical expenses following a Westminster hospital accused her of having an out-of-network procedure.
Lisa French went to St. Anthony North Health Campus to undergo a spinal fusion procedure in 2014 after being involved in a severe accident.
French had a T-bone injury and was experiencing issues with her neck and back. Doctors decided she required the spinal fusion procedure and informed French she was at risk of being crippled if injured in the same spot without operation.
She visited St. Anthony North, completed a paper stating she would pay for all expenses, gave them her insurance card, and was told that the patient’s responsibility for the procedure was approximately $1,337.
“I was delighted. That’s fair for my mind,” French said. “I’m not very knowledgeable in insurance, so I depend on the hospital or, as it were, insurance, or whoever I’m talking to help me through this.”
Insurance Card Misread
After the procedure, the hospital informed French that it had made a mistake. They had mistakenly read her insurance card, and she was later determined to be a non-network patient.
Then she was sent an invoice for $229,112. The total amount, which includes the amount owed by her insurance company, was $303,709.
“I was afraid. My husband was also scared. One of the first things we discussed was bankruptcy,” she said.
Around $197,000 included the hardware which was put into her back. French claims she and her lawyers discovered it costs approximately $30,000.
The couple ultimately ended up filing for bankruptcy. However, she consulted her insurance company and ELAP Services, a hospital bill auditing firm and decided to challenge the charges.
After years of filing legal documents, a trial lasting five days, and the appeal process, Colorado Supreme Court ruled in French’s favour.
It was decided that the document she signed mentioned charge masters in the agreements and that she was not aware of that billing and didn’t agree to the terms, so she isn’t liable.
Charge master Is Difficult To Comprehend
“The Charge master represents the total list of prices hospitals are charged for the many medical services they provide and… is a huge price database,” said Glen Mays, an associate professor of Health Policy at the University of Colorado School of Public Health.
Charge masters can be difficult for consumers to comprehend; they usually comprise tens of thousands in lines for individual prices that are intended to be processed by computers.
Recently, Colorado and the federal government have passed laws that increase transparency in hospital prices and end bill-for-services that are not disclosed. However, Mays claims that even these laws might not have made a difference in this particular instance.
“Even with these laws, it’s tough for consumers or patients to obtain meaningful information from these charge masters,” Mays said.
Centaur Health argued that the charge master system is a trade secret in court documents. Hospitals negotiate various discounts and prices with individual health insurance providers and with public programs such as Medicare or Medicaid to establish those costs.
With the charge masters in place, the justices made it clear that she couldn’t comprehend.
Centura Acknowledges That Charge master Is Difficult
“Centura has acknowledged that she could not be able to comprehend or comprehend the charge master’s nearly 50k codes. As a result, having access to charge master could not be a good way to establish mutual consent to any rate contained in them,” the Colorado Supreme Court decision stated.
Mays believes this system makes it hard for customers to shop to get the best price they could for other items and services. He also believes it is responsible for a large portion of the waste that is in the health system.
“This is the most fundamental flaw that is a fundamental weakness of this U.S. healthcare system. Before their visit, there is no way for individuals to have a realistic estimation of the cost of their health insurance,” Mays said.
In its decision that the state supreme court handed down. It stated that charge masters’ actions have become more inflexible. And, over time, lost all connection to the actual expenses.
French is thrilled that the case is over and hopes it will establish a precedent for other lawsuits later. French is now accountable for the remaining portion of her owed, which was $776 in all.
“I believe that hospitals are supposed to be there to assist patients and to help us understand what’s happening and not hide things and secrets,” she said.
However, Mays believes that the recent laws adopted at the national and state level are the first step. But it may be even more difficult for hospital costs, to be precise. In the meantime, he urges patients to inquire and shop around whenever they can.
Denver tried to contact Centaur Health for a statement regarding the incident but could not get a response.