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Attorney: Hospital ER Overcharges “Unfair”

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Los Angeles, CAUninsured patients who visit ER rooms are reportedly being hit with hospital emergency room overcharges, meaning they are paying far more for medical care and services than other patients are. Barry Kramer, of the Law Office of Barry Kramer, says uninsured patients do not have someone negotiating a discounted rate for services, and as a result end up being charged much more for hospital services than those services are worth. Kramer says he has seen clients who have had bills of between $5,000 and $10,000 for only a few hours stay in a hospital emergency room, often with little or no benefit. Those clients were unable to pay their bills and sought his help.

“Hospital ERs provide a common contract that everyone signs, but which doesn’t set out the specific charges,” Kramer says. “So an uninsured patient, even if he asks, has no idea of what his charges will ultimately turn out to be. He doesn’t find out the bad news until he leaves the hospital.”

According to Kramer, “Hospitals invariably claim that everyone is charged the same, which is simply untrue. Only uninsured patients are required to pay the hospital’s gross charges. Literally everyone else gets huge discounts.”

The problem has been particularly unfair to uninsured patients who are capable of paying their inflated bill, but faced with the choice of paying an unreasonable and inflated bill or confronting the hospital’s collection department and ruining their credit. Many of these patients found themselves uninsured either because they recently lost their job or were in the process of changing insurers, or simply felt the insurance costs were too high. For such patients, paying an unreasonably hefty hospital bill did not help their financial situation, but they were forced to do so because they could not afford to defend a lawsuit or have their hospital bill go to collections. What they paid, unfortunately, was often up to five times the amount that other patients paid for similar services.

“We are looking for patients who are uninsured, received an undiscounted bill from a hospital, and paid all or most of that bill,” Kramer says.
“For example, a patient might have cut his finger, waited two hours in the emergency room, received 10 minutes of treatment, and then been hit with an inflated bill of $1,200. If the patient begrudgingly paid the bill rather than face a legal battle or collections, he would be entitled to a refund to the extent of the overcharges.”

For people confronted with a hospital overcharge, an individual lawsuit is rarely feasible, given the costs and complexity of filing such a suit. Furthermore, few individuals have any understanding of hospital billing practices, which are largely hidden from the public. Thus, the cost of a lawsuit and access to billing information is more easily handled in a class-action suit.

Uninsured patients who have received care at a major hospital’s emergency room in the past three years and have paid all or most of their bill may be eligible to file a lawsuit against the hospital.

“There is a limited group that ends up damaged or injured by these Charge Description Master billing practices,” Kramer says. “The bottom line is that emergency room billing for uninsured is based on an unconscionable rate structure, which insured patients, Medicare patients and Medicaid patients don’t have to pay.

“Even the hospital contracts signed in an emergency room setting are deceptive, since they never explain the fact that an uninsured will be required to pay far more than others for the same services. It's a tainted system, and it works unfairly. Unlike other patients, uninsured patients have no rate structure agreed on in advance, and only after uninsured leave the hospital do they get hit with an exorbitant bill.”

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READER COMMENTS

Posted by

on
I just want to see if this is worth my time. Why is there not a class action suit against hospitals for over charging patients and insurance.

Here is what I mean, I had an accident on a 2 wheel motor vehicle. I broke or fractured my collarbone and and 2 or 3 ribs, it may have been 4 but they don't reset those, I also punctured a lung slightly, they did insert a tube to reinflate it but it was no big deal, I didn't really even feel the lung issue.

Anyway, the admitted me for 4 days even though the nurses seemed to think I was pretty ok, and I kept telling them I was ready to go home, well, by the 4th day one of the nurses said I could insist that they release me and I did, reluctantly they did, well, 4 days in the hospital racked up a $40,000 bill and that was just the hospital not counting all the many doctors that asked for a cut which I'm not even sure ever saw me..

Anyway, I called them and they did reduce the bills, I am self-pay.

I also had a hospital visit through the emergency room at another hospital several years before that and they cut the bill immediately on checkout 89%, so it actually cost me less than someone who has insurance that has to pay 20% when I only had to pay 11%.

What I am getting at is why isn't it against the law for hospitals to charge so much and why are insurance companies allowed to pay so much and charge so much to there policy holders.

Isn't this price gouging. It obviously doesn't cost the hospitals as much as they charge and I'm not sure that insurance companies are actually paying as much as they say they are.

Why isn't this a class action suit against the hospitals and insurance companies?

If you think this could lead into something that is worth my time, I will be happy to give you my full name and work this out with you, but if not, its no big deal.

Posted by

on
I was charged $4,900 for an X-ray and a soft cast (splint). $95 for the bill at the emergency room door (I have insurance) and my deductible is $500 more that I have to pay. My insurance pays the rest. That charge includes a "soft cast" for my hairline fracture. In fact, that is something my insurance did not cover or was something so expensive that my insurance only paid maybe about $1,500 for it. Took the NP and a desk worker about 5 minutes to put it on me. This is highway robbery. When will it stop? Maybe I could stop it once and for all -- if only I could get a jury trial and then win and the hospital appealed, then the appellate court would render a decision stating that this is simply obviously a gross overcharging for services. Of course I'd need an attorney ... but none will take on such a case. Just not a big money maker for the attorney. What needs to be done is the California constitution must be amended, and to set limits on charges for hospital services. Indeed, according to my bill, the hospital is charging $4,900 to provide an X-ray and a splint to a hairline fracture. This was the time it took to get an X-ray, and the time it took for an NP to say you have a hairline fracture, don't walk on it, and go see your GP. Again, this is highway robbery, and it has got to s top. That should not have cost more than, say, $200 for that application of the splint, and that is expensive but I could swallow that. But maybe someone thinks that the hospital needs to rip me off because . . . ??? like to hear why I should get ripped off, or what justifies ripping me off like this. (I am considering taking this to small claims myself, after I pay the additional $500, calling it price gouging and an unfair business practice. Can I sue the hospital at all? Do I have to file a government tort claim -- what barriers are in my way here? Again, I think that the solution is for the people of California to get together and amend the California constitution, to purge the state of these kind of corrupt medical practices.

Posted by

on
It has been a nightmare trying to negotiate with the hospital for my ER visit. If you are uninsured you literally have no voice and no recourse and the hospitals know it. I have tried for three years to get my bill reduced. I have tried to get help from so called advocacy groups, but there is nothing they can do but keep records consumers report to them about the hospitals (that are not allowed to be published). I know that I am being screwed and the hospital knows there is nothing I can do about it but pay up or declare bankruptcy. They are disgusting.

Posted by

on
i was hospitalized non insured had so many seprate doctor bills plus one from hospital who also charged me a sur charge i have not paid hospital bill but pay off all othr doctor bills over 1,500 i was tpld two years later that what they said was wrong was not why keep me in hospital when they only ran more tests and gave me medication could of did on outpatient basis

Posted by

on
I already posted once, but I wanted to provide more perspective regarding the situation I described, which I believe is criminal, fraudulent, a scam, and just plain wrong! These "outside" charges are being billed to those who are most vulnerable with no way to know what is being charged by whom. The ER physicians are not employees of the hospital and therefore bill separately and are NOT covered by the hospital copay. Is it just me, or does it seem wrong that some services within the hospital are provided by outside contractors and therefore can bill separately? What's next...the nurses form a separate business, contract with the hospital and bill separately? In any other business, if the business provides a quote (in this case the analogy to quote would be the expected co-pay) and then that business requires contract labor to complete some of their work, they pay the contractor and I pay the amount quoted...I don't pay for the outside contractor unless they explicitly tell me it's a separate charge (which, apparently, ERs do in fine print on a document dealt with during an emergency). ERs have found and exploited this loophole which really benefits insurers as well as the hospitals and outside providers who roam the halls as if they are on staff. This issue needs to be dealt with. Have at it on the class action!

Posted by

on
I went to the ER in 2011 around June or July. I had a piece of chicken lodged in my throat. it would not clear. I sat in the ER for 2 hours.Tried drinking water for a while. It finally cleared. My bill was over 2,000. For basically a glass of water..........

Posted by

on
Even with insurance and an ER co-pay, I received separate bills from the ER, with a co-pay, and the ER Physicians group - billed in full and not covered by insurance. Two separate bills...only one copay and the other owed to a group outside the hospital. A seemingly intelligent health care customer (like myself) would assume it's all covered under the ER co-pay. But that's NOT the case, so an assumed $200 trip to the ER balloons to over $1,000. Not like someone in an emergency situation has a choice. It's just WRONG.

Posted by

on
Mr Kramer is exactly right.I am one of those patients who have faced this same situation.After finding out this he decided to represent me in a class action as well.He and the other firm are continuing to battle this ongoing problem that only seems to be getting worse and not better.Only if all the Judges would see what is happening to these consumers in a unfair and deceptive way would make the fight against these hospitals much stronger and maybe start to control these problems.Anyone seeking advice and counsel he is the person to contact for these matters.Also note, I was in no way forced nor paid for my words of reference in this matter.My goal is too see these places put at justice for their wrong doings.They should not only be obligated to reimburse the patient but should be fined in a hefty way in my opinion.I encourage all who suffer from these matters to step forward and take charge in the fight.

Posted by

on
Unfair billing practices are not limited to the uninsured, in fact most people are paying high insurance premiums for high deductible plans, which means it's a double whammy. I work in the healthcare billing industry and I think knowing what I do makes this even more frustrating. Back in the "good old days" patients paid their insurance premiums and all they had to worry about was their $25.00 copayment. They may see the statement and question why the charge was so high for a minor problem that took about 10 minutes with the physician, but because the insurance paid all but their $25 copay, they didn't argue it. Well now with high deductible plans, most of the bill ends up being patient responsibility, so guess what happens now when patients see the large bill...the problem is they don't understand half the charges to be able to put up a fight. This was one of the original intentions behind creating this high deductible plans. The more skin you have in the game, the more you will pay attention. Sad that it's such a game, but that's the American way. It's all about the battle for the $$.

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