Hospitals May Overcharge

June 30, 2016 | Attorney, Matthew Dolman
Hospitals May Overcharge While living in America comes with its fair share of freedoms, healthcare isn't one of them. It's a well-known fact that if a person must go to the hospital for any type of care, the cost of this hospital visit or stay will be very expensive. But what if you learned that these expensive bills are actually overly expensive or are three, four or even more times expensive than what an insurance company would pay for the same exact treatment? Patients who are uninsured often pay the highest fees, leaving them to figure out how to pay the lavish bill back. Sometimes this means finding themselves the targets of collection agencies or in bankruptcy court. Fifty hospitals in the United States are charging uninsured consumers more than 10 times the actual cost of patient care, according to research published in Health Affairs. Twenty of these hospitals reside in none other than Florida. These hospitals have markups (ratios of charges over Medicare-allowable costs) approximately ten times their Medicare-allowable costs compared to a national average of 3.4. It's interesting to note that one for-profit hospital system owns half of these fifty hospitals. Collectively, this system has the effect of charging the highest prices to the most vulnerable patients and those with the least market power. As such, these patients happen to be middle-class Americans or people who are not poor enough to qualify for Medicaid or charity care. One in every six Americans are vulnerable to these upcharges; and once overcharged, these individuals face skyrocketing medical bills that can lead to personal bankruptcy, damaged credit scores or avoidance of needed medical care. So, isn't it illegal? Unregulated Chargemaster Lists The researchers said that the main factors that have led to overcharging are lack of market competition and the fact that the federal government does not regulate prices that health-care providers can charge. In the United States, hospitals have the chargemaster (CDM), a lengthy list of the hospital's prices for every procedure performed and for every item used during those procedures. However, most patients covered by private or government insurance don't pay full price. This is because insurers and programs such as Medicare negotiate lower rates for their patients. Conversely, the millions of Americans who don't have insurance don't have anyone to negotiate these prices down; therefore, they have to pay it full price or more [1]. Even so, patients rarely discuss prices with medical personnel before treatment because of patients' lack of time, ability and knowledge; physicians' professional norms against discussing fees; the complexity of hospital accounting; and the lack of price transparency. The researchers said that other consumers who may face these high charges without insurance advocacy were patients whose hospitals were not in their insurance company's preferred network providers, patients using workers' compensation and those covered by automobile insurance policies. “Simply speaking, a patient wanting to compare hospital prices faces a substantial information asymmetry for an elective procedure, and the time necessary to conduct price and quality comparisons is certainly not available in most medical emergencies. The result is a market failure that forces uninsured patients, out-of-network patients, and casualty and workers' compensation insurers to pay charges that are market up multiple times above costs and are much higher than what publicly insured and privately insured in-network patients pay. The current regulatory environment, unfortunately does little to correct this market failure. The extent of this market failure is especially salient in these fifty hospital.” [2] Florida's Share of the Fifty Hospitals The twenty hospitals that made this list were:
  1. North Okaloosa Medical Center (CHS)
  2. Bayfront Health Brooksville (CHS)
  3. Heart of Florida Regional Medical Center (CHS)
  4. Orange Park Medical Center (HCA)
  5. Oak Hill Hospital (HCA)
  6. Fort Walton Beach Medical Center (HCA)
  7. St. Petersburg General Hospital (HCA)
  8. Sebastian River Medical Center (CHS)
  9. Osceola regional Medical Center (HCA)
  10. Gulf Coast Regional Medical Center (HCA)
  11. South Bay Hospital (HCA)
  12. Fawcett Memorial Hospital (HCA)
  13. North Florida Regional Medical Center (HCA)
  14. Lawnwood Regional Medical Center & Heart Institute (HCA)
  15. Brandon Regional Hospital (HCA)
  16. Lehigh Regional Medical Center (CHS)
  17. Twin Cities Hospital (HCA)
  18. Regional Medical Center Bayonet Point (HCA)
  19. Bayfront Health Dade City (CHS)
  20. Kendall Regional Medical Center (HCA) [3]
* Bolded Medical Centers are located close to Clearwater and may affect you. Personal Accounts Unfortunately, figuring out hospital pricing and charges is one of the most infuriating experiences for consumers and health-care professionals. It is nearly impossible to find out ahead of time from the hospital how much a procedure or stay is going to cost. People like Lisa and Scott Starbuck from Knoxville, Tenn., learned this the hard way. The couple was making about $50,000 a year, before taxes, in the computer-consulting business they ran out of their home. About 10 years ago, both were laid off from their corporate jobs which also stripped them of their medical insurance coverage. Lisa was able to get insurance on her own, however, Scott couldn't afford insurance after he was diagnosed with diabetes. The couple tried to avoid going to the hospital, regardless of his condition. Unluckily, Scott began suffering chest pains and wound up in the emergency room at the University of Tennessee Medical Center—a nonprofit teaching hospital. The doctors diagnosed a mild heart attack. They had to insert two stents to open up a blocked artery to his heart. It was a pretty simple case with no complications and Scott was eventually released after 72 hours. Nevertheless, the big pain came later when the couple received his medical bill of more than $41,000. Lisa said, “The biggest thing on there was the stents. The two stents were $19,000. And I'm not a medical professional so I don't know a lot, but I just didn't see how that could be $19,000. So I got on the Internet and looked up the list price and it was $2,300.” After checking in with the manufacturer of the stents who assessed the same amount of money for each stent, totaling $4,600, the couple called the hospital back to see if it was a mistake and the hospital said that the prices were not negotiable. The hospital did offer a 25% discount if the couple were to pay it off in two years or less. However, Lisa and Scott still couldn't afford that so they were trapped with the original $41,000 bill. Soon a collection agency started calling their home to get the money owed and the couple had to consider bankruptcy [4]. Dolman Law Group Accident Injury Lawyers, PA The Starbuck's situation is an unfortunate reality that a lot of Floridians have to deal with. The information on the chargemaster list isn't available to patients and without comparable shopping, the hospital has no reason to control prices. This legal and often unregulated process is done so because everyone is charged the “same amount”. The difference between the uninsured and insured is that the insurance companies who represent the insured dictates to the hospitals what it's going to pay; same thing with the Medicare program--both profit if they pay less. Regardless, outrageous bills can sometimes be the act of negligent medical centers looking to make more money than legally possible. Or these centers who pay other collection agencies to pursue the debt owed sometimes hire agencies who illegally harass victims. Either way, if you or a loved one believes that they are being unfairly charged in their medical billing or are being harassed by collection agencies to do so, we have experienced personal injury lawyers who are here to help. It's hard to understand what to do after a massive bill comes in the mail and you as a consumer, have to figure out how to pay an unjust healthcare system. Don't do it alone. If you have any question or would like to set up a free consultation and evaluation of your claim, please call the Dolman Law Group Accident Injury Lawyers, PA at (727) 451-6900. Dolman Law Group Accident Injury Lawyers, PA 800 North Belcher Road Clearwater FL, 33765 (727) 451-6900 References: [1] [2] Extreme Markup: The Fifty US Hospitals With The Highest Charge-To-Cost Ratios [3] [4]


Matthew Dolman

Personal Injury Lawyer

This article was written and reviewed by Matthew Dolman. Matt has been a practicing civil trial, personal injury, products liability, and mass tort lawyer since 2004. He has successfully fought for more than 11,000 injured clients and acted as lead counsel in more than 1,000 lawsuits. Always on the cutting edge of personal injury law, Matt is actively engaged in complex legal matters, including Suboxone, AFFF, and Ozempic lawsuits.  Matt is a lifetime member of the Million Dollar Advocates Forum and Multi-Million Dollar Advocates Forum for resolving individual cases in excess of $1 million and $2 million, respectively. He has also been selected by his colleagues as a Florida Superlawyer and as a member of Florida’s Legal Elite on multiple occasions. Further, Matt has been quoted in the media numerous times and is a sought-after speaker on a variety of legal issues and topics.

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