Texas Supreme Court favors Patient in Hospital Overcharging Dispute "This will reduce the price-gouging schemes that are just rampant right now.”

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May 7, 2018 No Comments ›› admin

By Lynn Woolley

There was a time when you went to the doctor, got treated, paid a fair charge and went home. But in today’s government –regulated, insurance-driven atmosphere, medicine is big business, and hospitals need to rake in every cent they can.

When Crystal Roberts landed in the emergency room at North Cypress Medical Center in Harris County in June 2015, she got a bill for more than $11,000 for X-rays, CT scans and other tests.

Roberts had been in a car wreck – and she was uninsured.

Roberts thought that amount was excessive and was more than an insurance company would have been charged. Texas law requires hospitals to charge uninsured patients a “reasonable and regular rate.” She sued, asking to know what her insurance company would have been billed – had she had one. The Texas Supreme Court has now ruled, 6 to 3, that she must be given the information.

The central question in this case involves whether big insurance companies can cut a better deal.

Most people believe they can, and do.

The question is – why? It would seem logical that, if an uninsured person is willing to pay cash, the individual should get the better deal. After all, if someone is willing to pay the cost in a lump sum, or in monthly payments, that eliminates a lot of red tape. It also means more money for the hospital over the long run.

But hospitals don’t see it that way. 

North Cypress Medical Center (from hospital website)

I had a hernia fixed three years ago – and I had company-provided insurance with a high deductible. I ended up owing thousands of dollars out of pocket. I visited the hospital business office with a checkbook, wanting to make deal. Lower the cost, I said, and I’ll write a check right now.

I was hoping to get a thousand dollar discount or something akin to that on a statement of several thousand – about $13,000 as I recall. (Note that I had no idea going in what this operation was going to cost. I was simply told that it had to be done.)

The hospital would not consider it. I paid the bill monthly until it was paid off. The hospital got the entire amount – but had to wait to get it. That’s what they preferred – having the debt on the books as a receivable instead of getting a slightly smaller amount up front.

But look at what hospitals must contend with.

• Medicare
• Medicaid
• A cornucopia of private insurance companies
• Government regulations (they cannot refuse service)
• Illegal immigrants (they cannot refuse service)
• Obamacare

This is why we’ve seen the spate of mergers.

Hospitals are trying to be big and bigger so that they have a seat at the table when government starts running everything. Remember, the Affordable Care Act, though grossly misnamed, was a wet dream of the Left for decades. After it proved unworkable, left-wing socialists like Bernie Sanders simply answered that we need a single-payer system. That would make government everybody’s insurance agency.

Meanwhile, the Obama administration couldn’t even get their website to work.

So blame a lot of this out-of-control price gouging on government.

Back when medial administrators ran hospitals, doctors doctored, and politicians stayed out of the way, costs were cheaper. All the government control combines with expensive new technology to drive up costs. Add the fact that doctors are highly compensated (rightly so) – and you see why hospitals squeeze every cent they can.

Video: “The Cost of Admission” – 60 Minutes report from 2012 by Steve Kroft.

But when it’s not fair – that’s a problem.

North Cypress Medical Center did not want to provide information to Crystal Roberts regarding what they would have charged an insurance company in her case. They said providing such information would cause “irreparable harm” to them if they disclosed “confidential and proprietary” insurance information.

Texas Supreme Court Justice Debra Lehrmann

On April 27, 2018, the Texas Supreme Court sided with Ms. Roberts.

This could be a landmark decision – especially for people who want to challenge their high hospital bills. The decision, written by Justice Debra Lehrmann, will make it easier for uninsured people to negotiate their bills.

Specifically, they can now ask for data on what would have been billed to an insurance company – and then offer to pay that amount. Remember, Texas law somewhat vaguely states a requirement of a “reasonable and regular” rate — presumably, the same rate as the insurer would have been billed.

Roberts’ lawyer, James Amaro told the Texas Tribune that this ruling tips the scales to the side of the patient:

“No mechanism has existed to challenge excessive hospital bills for uninsured accident victims. This will reduce the price-gouging schemes that are just rampant right now.”

We’ll see.

Due to our current healthcare system of government regulations, Medicare & Medicaid, insurance company rules, high deductibles, expensive technology, and the elimination of competition through mergers – it’s nice to see even a small advantage for consumers.

Healthcare may not be a constitutional right – but it’s something we all must have.


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