By: Peter Vieth April 22, 2016
For what may be the first time in Virginia, a judge has ordered a hospital to slash its “balance billing” charges by 75 percent to reflect the hospital’s usual write-off for uninsured patients.
In a balance billing dispute with a patient, a judge has ordered Martinsville (Va.) Memorial Hospital accept 25 percent of its chargemaster rate as payment-in-full for care provided to a patient with coverage from a non-contracted insurer, reports Va. Lawyers Weekly.
Memorial Hospital is owned by Brentwood, Tenn.-based LifePoint Health.
Below are five things to know about the lawsuit.
- After experiencing chest pains, Glenn Dennis was rushed by ambulance to Memorial Hospital where he received emergency care for a heart attack. Mr. Dennis’ attorneys said he spent two days in the hospital, during which he underwent surgery to place five stents in his arteries, according to the article.
- The hospital said Mr. Dennis’ bill totaled $111,115.37 Mr. Dennis’ insurance did not have a negotiated contract with Memorial for reduced reimbursement rates. The patient and insurer paid a combined $27,254, which Mr. Dennis contended was sufficient reimbursement.
- In response, Memorial sued Mr. Dennis for the outstanding $83,860.42 on his account and demanded the patient pay the amount in full.
- In court, Mr. Dennis argued his payment was sufficient because the hospital accepts 25 percent of prices specified in its chargemaster as payment-in-full for care to uninsured patients.
- In an opinion issued March 31, the judge ruled the reasonable value of Mr. Dennis’ medical care was $27,778. The patient would owe the hospital $523.89 in addition to his previous payments.
The decision is rare judicial rebuke to the common hospital practice of billing full rate for patients whose insurance plans do not have …
Read more: http://valawyersweekly.com/2016/04/22/challenge-to-balance-billing-stings-hospital/#ixzz47374VcEo
