Not only that, it’s the poor, the uninsured, and members of minority groups that are being squeezed the hardest and ending up with the most expensive medical treatment, according to a recent study done by Johns Hopkins researchers and published in Jama Internal Medicine in August, 2017.
Heard That Before
No surprise to veteran attorney Barry L. Kramer, from Kramer Law in Los Angeles, California.
Kramer regularly represents uninsured patients saddled with huge hospital bills they can’t pay. They turn to Kramer for help because they are being hounded by a collection agency hired by the hospital to get the money.
“A lot of uninsured people want to pay their bill. They were treated in the emergency department, they received the service and they want to pay,” says Kramer. “But the hospital is charging them way more than it should have.” They shouldn’t have charged the patient $8,000.
“If you look at the hospital’s master list of what it charges for specific services you’ll see that the uninsured patient, for example, pays $8,000 for a particular service, while Medicare would only be paying a $1,000 for the exact same thing.
“The uninsured patient is paying 8 times as much. It’s unfair. It is unconscionable billing,” he says.
Uninsured Get Settlement
Several years ago, Kramer filed a class action lawsuit against Swedish Health Services in Washington State. The lead plaintiff, an uninsured patient called Chad Humphrey, brought the suit on behalf of himself and other uninsured patients who had been treated in one of Swedish Health Services four hospital emergency rooms in the state.
Humphrey contended, according to the settlement agreement, among other things, that “Swedish’s charges to uninsured patients were greater than those charged to other patients for the same treatment, were unreasonable and not authorized by its Condition of Admission forms.”
There were a potential 50,000 other uninsured patients that had been treated and billed by Swedish.
Swedish vehemently denied overcharging and admitted no liability. It settled the case with Humphrey and the other plaintiffs to save time and costs associated with going to court, according to the settlement agreement filed in the Superior Court of Washington State dated August 8, 2014.
Hospital Charges Vary Widely
The 2017 Johns Hopkins study looked at the billing records of 1,200 emergency room doctors from across the US. It found, on average that patients paid 340 percent more than what Medicare patients paid for everything from sutures to CT scans.
“There are massive disparities in service costs across emergency rooms and that price gouging is the worst for the most vulnerable populations,” Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the study’s senior investigator said in a Johns Hopkins press release in 2017. “This study adds to the growing pile of evidence that to address the huge disparities in health care, health care pricing needs to be fairer and more transparent.”
How Does that Happen?
When a patient who is covered by insurance arrives in the emergency department the hospital will have to check with the insurance company to get cost approval for the CT scan or MRI or a list of expensive lab tests before the procedures are done. The insurance company will want to know what the procedure is for and whether it is absolutely necessary.
“The hospital won’t order the CT scan for an insured patient because they know the insurer won’t pay unless it is a necessary test,” says Kramer. "But it is a different story when it comes to uninsured patients."
Plus, any services rendered to the insured patient will be charged at the discounted rate that the insurance company has negotiated with the hospital.
READ MORE EMERGENCY ROOM CHARGES LEGAL NEWS
When uninsured patients asks about costs for a particular treatment or test they sometimes don’t get a clear answer according to Kramer.
“CT scans, room charges, lab tests, lab reports,” says Kramer. “It’s outrageous. All these huge bills run up generally to tell you there is nothing wrong,” says Kramer.
Uninsured patients with big bills should first question whether the emergency room bill matches the services they received. If it was too high, and they go the class action route, the hospital might end up paying them.