Michael Levenson reports for the New York Times on a woman who had to go to court to avoid paying hundreds of thousands of out-of-pocket health care costs. The woman, Lisa Melody French, went to her local hospital for back surgery. The hospital told her to expect about $1,300 in out-of-pocket costs given her health insurance; but, because she received out-of-network care and the hospital “misread” her insurance, it charged her $229,000.
If you’re hospitalized and have commercial health insurance, including Medicare Advantage, you could be faced with higher out-of-pocket costs than you expected. You have little control over the doctors who see you and are at high risk of out-of-network doctors providing your care. They generally can’t charge above Medicare’s rate, but that can still be a lot. That said, depending on your income, you could qualify for charity care if you are in a non-profit hospital.
Ms. French challenged her hospital charges in Colorado state court. Fortunately, the Colorado Supreme Court ruled in her favor. She was liable for only $766.74. It took eight years for her to get that decision.
How did Ms. French end up with more than $200,000 in out-of-pocket costs? Centura Health, which runs the hospital that provided the surgery, billed her because her providers were out of network and her insurer would not cover their charges. And, Ms. French signed two agreements to pay all hospital charges after the hospital told her that her estimated out-of-pocket costs would be $1,300.
Out-of-network rates can be ridiculously inflated: The out-of-network charges were the hospital’s full rates–the amounts listed on its “chargemaster.” The court ruled in Ms. French’s favor because she did not know there was a chargemaster and had never agreed to pay its rates. The hospital did not tell her anything about the chargemaster nor would it disclose the chargemaster during the litigation, claiming that the chargemaster was proprietary, a trade secret.
Hospitals should not be able to charge any rate they please for out-of-network care: Chargemasters “have no basis in reality,” according to Gerard Anderson, a Johns Hopkins professor. They are not tied to the actual cost of a given treatment or procedure. Likely for this reason, hospitals tend to keep them confidential. President Trump ordered that hospitals make this information public, but they have never done so in a way that anyone can understand.
Patients have no way to comparison shop for hospital care: Since patients have no clue what procedures providers will undertake, no control over them and little information about their costs, patients have no way to comparison shop for their care.
What if you’re in a Medicare Advantage plan? As with insurance for working people, with Medicare Advantage plans, corporate health plans that cover Medicare benefits, your costs can be insanely high, especially if you’re in an HMO; in an HMO, if you see out-of-network providers, there is no limit on your out-of-pocket costs.
Here’s more from Just Care:
Leave a Reply