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Hospitals Overcharging Insured and Uninsured Patients


Both insured and uninsured hospital patients allege they are charged excessive health care costs because of hospital overcharging practices. From surgery costs, to administrative fees, to equipment charges, hospitals and clinics routinely overcharge their patients for services.

Insured patients with big deductibles face rising insurance premiums and out-of-pocket expenses for hospital visits or routine hospital tests.

Uninsured patients may be paying extra for their hospital expenses compared with what an insurance company is charged for the same procedure. Some uninsured patients are forced into collections to pay for bills that are reportedly inflated.

Both Insured and uninsured patients may discover that they cannot be reimbursed for services rendered if their ailments turn out to be less serious than initially feared.

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Overcharging Practices – Insured Patients

As hospital billing practices become increasingly complicated, patients rarely know in advance what they’ll have to pay.

Hospital overchargesExcessive Facilities Fees
Hospitals often charge a facility fee on top of a doctor's fee or a fee for services. Federal law allows hospitals to charge facility fees for outpatient services at affiliated clinics, but patients are being charged facility fees of up to hundreds of dollars out-of-pocket without warning and without the ability to dispute them. Sometimes the facility fee is higher than the cost of the physician’s services.

Room Overcharge
A physician releases a patient from ICU to a regular room, for example, but the patient is taken to a private room instead of a semi-private room. A patient should not be billed at a private room rate when a semi-private room is not available or not requested by the patient or physician.

Upcoding
Ninety percent of bills have coding errors, which can mean you have been overbilled or didn’t deserve bill in the first place. Upcoding is often exposed through Hospital Overcharging lawsuits. The Center for Public Integrity claims such practices have cost the Medicare program more than $11 billion in fraudulent fees. Doctors in hospitals determine which code to enter into insurance forms for the care they provide, and the more complex the care, the bigger the bill. As a result, what doctors get paid increasingly reflects more on their “coding” skills than clinical ability.

Out-of-Network
When a doctor, hospital or other provider accepts your health insurance plan, they’re in network. When you go to a doctor or provider who doesn’t take your plan, they’re out of network – and you can wind up with exorbitant overcharges.

Your out-of-network hospital service could also be the radiologist who reads your X-ray, the anesthesiologist assigned to your operating room or the doctor assisting your in-network surgeon.

Depending on your insurance policy, you may be required to pay the difference between what the insurer reimburses and what the provider charges in out-of-network situations. And charges are often arbitrary: what might cost one patient $200 could cost another $2,000 or more. Whenever possible, before you go to a hospital, it’s always a good idea to ask beforehand if they take your plan.

Balanced Billing
Say a hospital doctor charges $250 for a service. Your Insurance plan’s approved amount is $190. So you “save” $60. On your claims and explanation of benefits statements, these savings are listed as a discount. Doctors or hospitals not in your health insurer’s network don’t accept that approved amount. You’ll be responsible for paying the difference between the provider’s full charge and your plan’s approved amount.

Hospitals claim they need balanced billing to offset the cost of treating uninsured patients. However, some states have passed laws that bar out-of-network doctors from balance billing patients who receive care at an in-network facility.

Chargemaster
Providers often give insurers big breaks on quoted rates. Out-of-network patients initially get billed at so-called chargemaster rates -- a computerized database containing the full “retail” price for every service rendered in a hospital. But the price can be inflated up to 10 times the actual cost to the hospital, as reported by Steven Brill in TIME(2013), titled “Bitter Pill.”

Uninsured Patients
Insurance companies rarely pay the chargemaster fee for any medical service because they have negotiating clout.

But that doesn’t apply to uninsured patients, who also have the right to know in advance when a hospital intends to charge $15 for an aspirin or $100 to turn on the overhead light in an operating room. Not all states have passed hospital fair pricing laws, so uninsured patients often get stuck with exorbitantly high bills. And when they can’t afford to pay, collectors are calling. Each year, third-party debt agencies rake in approximately $21 billion in past-due healthcare bills, keeping a significant proportion of the payments for themselves.

Over-Treated
Another common practice is billing for more intense treatment of a condition than was actually required or rendered.

Overcharging in California Hospitals

The two biggest hospital chains in California—Sutter Health and Dignity Health, were found in a 2016 study to charge 25 percent more than at other California hospitals. These giant health systems used their market power to drive up prices, resulting in the average patient admission at both chains nearly $4,000 more expensive, according to researchers at the University of Southern California. And the University of California, Berkeley examined the consolidation of the hospital, physician and health insurance markets in California from 2010 to 2016. The authors said 44 of California's 58 counties had "highly concentrated" hospital markets. For instance, obstetricians employed by Sutter Health are reimbursed approximately three times more for the same service than independent doctors, according to a KHN review of OB-GYN charges on several insurers' online cost estimators, making Northern California arguably the most expensive place in the country to have a baby.

(The attorney general's office has filed a lawsuit and a class action against Sutter Health. The trial is scheduled for June 2019 in San Francisco. )

Uninsured Hospital Patients

Patients without insurance who are treated in hospital could face bills that are inflated when compared with what insurance companies are charged for the same procedure. Uninsured patients in California, Texas, Florida, Arkansas, New York, and North Carolina could be paying 2-4 times the rate insured patients pay for the same treatment.

People who are not able to pay their bills could find they are sent to collections agencies and have their credit ruined. Because many people are in medical distress when they visit emergency rooms, they may not have the capacity or the ability to understand or sign documents before medical care begins.

Hospital Overcharge Lawsuits

Patients--whether insured or uninsured-- who believe they have been overcharged for treatment in a hospital should seek legal advice before attempting to fight the bill. One lawsuit was filed in 2015 by a patient who was charged $31,000 for a one-week stay in a hospital. The patient, Claire Amos, filed the lawsuit alleging she and other uninsured patients were billed at a rate that was "dramatically higher" than the rate charged to patients with Medicare and Medicaid. The lawsuit seeks class action status.

Experienced attorneys have successfully fought hospital bills, and they can help you dispute excessive hospital overcharges.

Hospital Overcharging Legal Help

If you or a loved one has suffered similar damages or injuries, please click the link below and your complaint will be sent to a lawyer who may evaluate your claim at no cost or obligation.
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HOSPITAL EXCESSIVE BILLING LEGAL ARTICLES AND INTERVIEWS

Patients Battle Surprise Emergency Room Charges
Patients Battle Surprise Emergency Room Charges
February 20, 2019
Washington, DC Dr. Joaquin Lopez ‘s surprise emergency room bill came after he and his insurer had already paid $11,000 toward the cost of emergency gallbladder surgery. For dentist Brad Buckingham, who fell off his bicycle, the shock was a $70,000 bill to repair a broken hip. For Stacey Shapiro, it was a $6,720 emergency room fee to treat sudden spell of low blood sugar READ MORE

Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes
Discrepancies in Emergency Room Overcharges Cause Frustration and Financial Woes
February 11, 2019
Scottsdale, AZ: Emergency room care in the US is the highest-priced care a patient can receive. Even a minor condition can set you back thousands of dollars, which in itself can cause health issues—financial problems are stressful. It can get worse: one patient dinged with outrageous emergency room overcharges later discovered that another patient with similar treatment paid a lot less READ MORE

ER Charges: Underserved and Over-Charged thanks to Upcoding
ER Charges: Underserved and Over-Charged thanks to Upcoding
January 10, 2019
Los Angeles, CA: When a nine-year old accidentally had gasoline splashed in her eyes, her mother immediately drove her to the closest hospital emergency room. They were directed to the eyewash station but it was so dirty they couldn’t use it, so Brianna’s mom rinsed her daughter’s eyes at a regular sink. Turns out, they would have been better off using the gas station’s eyewash, which was free. The ER sink cost $1,400: the hospital charged $600 and the ER doctor fee was $800 (for walking into the room, saying Brianna needed an eyewash station and walking out). Upcoding has become common practice, resulting in emergency room overcharges and increased health costs for everyone READ MORE

READER COMMENTS

Posted by

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I took my daughter into the emergency room because she was having a lot of abdominal pain they ended up removing her gallbladder and putting a stent in for the stones she was in the hospital for about a week they charged $159,000 to my insurance and our portion was about 39,000

Posted by

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I went to the hospital because a drunk friend of my neighbor pulled out of my driveway with passenger door open and i was standing in front of it and she knocked me straight backwards on to the cement. Later on I go to the hospital to check on my head. i told the nurse i basically got knocked down by a car in my driveway. I leave hospital, i had insurance when i went so i was covered by medicare, but they sent me a $5000 bill because i did not press charges on the girl i barely knew her, and i was more concern with having a concussion than filing a police report about a girl i barely knew from the bar. When i called st mary's about the bill she tells me because i did not report the incident that i would not be covered!!! How unfair, im injured, im the victim, and they charge me because i dont file a report. i could have told them i fell down the stairs if i wanted too, and would i need to file a report on that??? Just makes me think people would rather be lied to, or they got seriously unjust rules.

Posted by

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I was charged $5,000 for a endoscopy yesterday that only took 45 minutes and then they almost killed me halfway thru the colonscopy and had to stop because my blood pressure dropped to 30 and i was almost dead. please contact me about a possible lawsuit. He said he couldnt finish the colonoscopy because he didnt know how to stablize my blood pressure? I am a senior on medicaid. w t h?

Posted by

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I was charged $17,633.70 at Texas health Huguley hospital for 1 E.R. visit that was NO procedures done, NO test, only a urine test and 4 hours in lobby and 2 hours in room. Sent home with a prescription. And 2 weeks later a bill for 17,633.70 WOW fraud fraud

Posted by

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I'm in distress I have thousands of dollars in overcharged hospital visits that I didn't even go these bills have messed up my credit totally have seven- or emergency and I have Medicare please contact me as soon as possible I have the bills to show I have the credit report to show how this is a medically affected my life I'm 35 years old and never had a credit card in my life now everything is messed up thank you for your time

Posted by

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My friend, a resident from Germany had jaw/sinus pain. She went to Scripps ER to get it checked. The doctor looked in her mouth... did not check her nose or ears... quickly prescribed an antibiotic and a decongestant. She received a bill for over $1,000. 00. The "itemized" bill said ER visit. Nothing else. No one offered a German translator. She tried to talk to billing. They either aren't available or are having "technical" problems. Absolutely ridiculous!

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