Challenge To ‘Balance Billing’ Hits Hospital

Virginia Lawyers Weekly

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.

  1. 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.
  1. 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.
  1. In response, Memorial sued Mr. Dennis for the outstanding $83,860.42 on his account and demanded the patient pay the amount in full.
  1. 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.
  1. 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 …

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