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Emergency Room Cost Overcharges
Most everyone knows that receiving emergency room treatment may be expensive, but sometimes it is unavoidable. People end up in a hospital ER for a number of reasons: they don’t have a regular doctor; their heart is pounding; they have suffered an injury; a dog bite or a severe allergic reaction requires immediate attention.
Uninsured Emergency Room Cost
Whatever the situation, patients who are uninsured and don’t qualify for Medicare, Medical or other state-provided coverage can see emergency costs anywhere from 2-4 times the rate of insured patients for the same exact ER treatment. This practice is not only grossly unfair, but it often impacts those least able to pay such excessive ER charges. As a result of over-billing, uninsured patients end up leaving the emergency room with bills that are completely out of proportion to those people with medical insurance for the same ER treatment rendered.
More than 46 million Americans do not have health insurance. When these people are unable to pay outrageous emergency room overcharges, they can become harassed by collection agencies, have their credit ruined, or even wind up in bankruptcy court.
ER Charges for Uninsured Patients vs. Insured Patients
Hospitals nationwide charge their so-called grossly inflated “retail prices” to their uninsured patients, whereas insured patients typically are charged rates 50-75 percent less. This means that uninsured patients end up being billed for emergency room care at double or triple the rates charged to the insurer of the patients sitting right next to them in the ER, for the exact same treatment.
For instance, an uninsured patient may be billed $15,000 for a single overnight stay, which includes diagnostics—scans, x-rays, etc.—any treatments, and drugs. But an insurance carrier will typically be charged $3,000-$5,000 for the exact same stay and treatment. The same is true with minor injuries, such as a dog bite. In such a case, an uninsured patient might be charged $800 for a few shots and stitches, whereas the insured patient's carrier is charged $250.
While attorneys advise ER patients to check their hospital admission agreement and inquire as to potential charges before signing on the dotted line, unfortunately, in a true emergency, careful review of the emergency room admission agreement may not be feasible. As such, an uninsured emergency room patient may simply wind up at the mercy of high emergency room costs and only realize his excessive emergency room bill later on when it's too late.
In May 2013 the Centers for Medicare and Medicaid Services released data listing “average” hospital charges for common medical procedures. Data shows hospital charges and the amount that Medicare paid.
Medicare Charge Data
Medicare collected cost report data from 3400 acute care hospitals in the US (VA hospitals and childrens’ hospitals are not included) and compiled the 100 most common procedures billed to Medicare. Inpatient services are bundled. For instance, if you have a heart attack Medicare pays a standard amount for all the hospital care associated with that treatment.
In many cases there are wide discrepancies for hospital charges, including emergency room charges. For instance, Jackson Memorial Hospital in Miami lists the average cost of a pacemaker implant at $66,030 while its neighbor, The University of Miami Hospital, charges $127,038.
“Our goal is to make charges more transparent, so that a consumer/patient can see not only what their local hospital charges for a procedure but also other hospitals in their community,” said a Medicare spokesperson.
The Bayonne Medical Center in New Jersey charged on average of $120,040 to treat transient ischemia, a type of small stroke that has no lasting effect, according to the New York Times (May 2013). That was 5.6 times the national average and 23.6 times what Medicare paid. Bayonne is privately held and follows a financial strategy used by a small number of hospitals to increase their profits by “going out of network” — severing ties, and hence contractual agreements that limit reimbursement rates, with large private insurers.
Patients treated in a hospital emergency room outside their provider’s network have to pay out of pocket only what they would have paid if the hospital was in the network, as stipulated under New Jersey law. An out-of-network hospital, however, can bill the patient’s insurer at whatever rate it chooses. Although the insurers can negotiate with the hospital, they typically end up paying more than they would have under a contractual agreement.
Approximately 1 million patients received refunds or hospital bill adjustments under class action settlements reached between the years 2006-2008. Hospitals paid back almost $1 billion to patients who were overcharged, mainly by providers of emergency medical care.
Emergency Room Overcharges Lawsuits
An emergency room overcharges lawsuit against Swedish Health Services, filed in King County, Washington Superior Court in June 2013, has been certified to proceed as a class action.
Emergency Room Overcharges Class Action Lawsuits
The class action, Humphrey vs. Swedish Health Services also known as Swedish Medical Center, alleges that Swedish Health Services “charged unfair, unreasonable and grossly inflated prices for emergency care provided for uninsured patients”. Humphrey was billed gross charges, a significant amount more than the hospital charges a public or private insurance company. The lawsuit claims the hospital charges uninsured patients about three times the average reimbursement amounts from other patients for the exact same emergency care. The plaintiff, Chad Humphrey, was uninsured when he received treatment at the ER of Swedish hospital in Issaquah twice in May 2012. He was charged more than $10,000.
Humphrey’s attorneys, including Barry Kramer, said the lawsuit could cover people who were treated at the emergency rooms during a period of, at the most, six years before the lawsuit filing date of July 31, 2012. Potential class members can decide to join the ER overcharged lawsuit to seek reductions or reimbursements of some of the amounts charged at Swedish emergency rooms.
Emergency Room Overcharging Legal HelpIf you or a loved one has suffered similar damages, please click the link below and your complaint will be sent to a Personal Injury lawyer who may evaluate your claim at no cost or obligation.
Last updated on Nov-26-13
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Emergency Room Charges, Hospital Overcharging Not a New Problem
New York, NY: It seems that our awareness of high emergency room charges and other bills stemming from emergency room cost is a more recent phenomenon. This is especially true amongst recent allegations by critics that many hospitals will inflate the cost of care for well-heeled patients or those with robust health care plans, in order to offset losses incurred through the provision of treatment for individuals without the means to pay at all, or with limited resources [READ MORE]
ER Overcharges—No Rhyme or Reason
Orlando, FL: Denise knows firsthand that uninsured patients are charged more than those insured for emergency room visits. She believes that some faith-based, not-for-profit companies that run hospitals actually profit from emergency room overcharges [READ MORE]
Attorney Files ER Overcharges Class-Action Lawsuit
Los Angeles, CA: Attorney Barry Kramer has filed a class-action claim on behalf of uninsured people who were overcharged emergency room (ER) fees by the Swedish Medical Center. “We have filed a class action in the state of Washington. The class has been certified and individuals affected by ER overcharges will soon receive notice,” says Kramer [READ MORE]
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