Small claims court flips the power balance in medical billing disputes. Pat Pawlowski shows us how it’s done.
By MARSHALL ALLEN – OCT 17, 2023
When Pat Pawlowski got tired of a health system’s lame excuses for a bogus medical bill he did what we should all do in the same situation.
He sued them.
What? Can a patient do that?!
Friends, let me share a reason I’m proud to be an American. Our wise ancestors established small claims courts to protect people from getting screwed by predatory practices.
That includes predatory billing practices, which afflict our nation.
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The underdog wins every day in small claims court. The courts operate in every state and allow people to represent themselves – saving the cost of an attorney – to sue an opponent in a dispute. It’s a fantastic venue to protect yourself against predatory medical billing practices. And the monetary limits, which vary by state, are often higher than you think, from $2,500 in Kentucky to $25,000 in Tennessee, according to NOLO.
The limits are plenty high to cover many common medical billing disputes.
I show how you can sue bogus medical billers in my book, Never Pay the First Bill, and my video curriculum based on the book, The Never Pay Pathway. Check out those resources to learn, and let me know if you need assistance.
Pat read my book – twice! – but he also came to his billing dispute with his own special set of skills. He’s not an attorney, but the 65-year-old spent his career as an insurance claims adjuster, litigation manager and regulatory compliance director. Pat knows numbers. He knows regulations. He knows compliance.
He’s also got an edge on him. “I’ve always had a bone to pick,” Pat told me.
Pat wasn’t going to sit back and let himself get ripped off when he got overbilled for a couple of routine blood tests.
Pat lives in a small town in Minnesota where a big health care system runs a clinic. In October 2022, he went to the clinic for a lipid test and a hormone test. He’s on a high deductible health plan, so he got the cash price up front and said he would not be using his insurance. They told him it would be around $100 for both tests.
The clinic ended up running five tests and billing his insurance, without his permission. Contrary to popular belief, the discounted insurance company prices are often higher than cash prices. Pat confirmed that the hard way.
Pat’s medical bill came to $582. Almost six times the estimated cash price.
Pat tried getting the clinicians at the clinic to correct it. They agreed that it should have been “zeroed out,” he said. But the health system’s billing department wasn’t having it. He had eight conversations with the billing reps over seven months and got nowhere.
Thus, Pat paid his $75 fee and followed the process on the small claims court website to file his case. “It’s pretty simple,” he said.
Pat said he’s sued in small claims court about a half dozen times in his lifetime. The key to a good filing, he said, is to address the court in your filing like you’re telling your story to your friend. Make it clear, concise and non-confrontational.
Present the facts to the court and then ask, “Is this right or wrong?” Pat explained. “This is what happened. I don’t think it’s reasonable. Do you think it’s reasonable?”
Then tell the court what you’d like done about the problem. Here’s how Pat summarized his case:
Defendant continues to bill plaintiff for medical services that were not medically necessary, not requested by plaintiff, not known to plaintiff before billed and for services not received despite advice from [clinicians] that charges to the plaintiff were to be ‘zeroed out’.
Pat also made a clear request of the court:
Plaintiff requests cancellation of all charges ($552.90) or reduction to amounts applicable to the requested services ($234.). Note that the reasonable and customary charges for the requested service is commonly expected to be $94.
Pat filed the case on July 6, court records show, and the hearing date was set for September 1. The hearing was set to be held via Zoom.
So convenient. You won’t even need to get a babysitter. Or wear pants!
Two days before the hearing, Pat received a certified letter from the attorney for the health system. It simply said: “Our Revenue Cycle Department has adjusted the October 26, 2022 lab charges on your account to a zero balance.”
In exchange, the attorney asked Pat to drop his case.
Good idea! Pat took the deal.
It was kind of funny to get the rapid settlement after many months of phone calls, Pat said. Clearly, the attorney didn’t want to take the time to deal with the case.
Small claims court favors patients in bogus billing cases for several reasons.
Suing a bogus biller in small claims court changes their incentives. Suddenly it is going to cost them time and money to defend their bogus bill. Pat estimated the hassle would have cost the health system about $2,500 in staff time. That doesn’t make sense for a $552 dispute.
Small claims court levels the playing field. It takes the dispute outside of their bogus billing system where they delay and ignore the issues. Suddenly they will have a court rule on their behavior. They don’t want that.
Small claims court creates accountability. The health care power players often care more about their reputation than they do how they actually treat people. A court case is public. The outcome is available for everyone to see.
I like to put it this way: We need to give bogus billers the incentive they need to be fair with us.
What’s the risk? You could lose and be ordered to pay the full amount of the bill. The same bill they’ve levied against you.
How do you know if your bill is bogus? It’s not difficult. My book and videos walk you through it. Check them out.
Pat’s only regret is that he didn’t sue sooner. “You’ve got nothing to lose,” he said. “You have somebody who will hear your story.”
Bravo to Pat for his win and for showing us all how it’s done. Plus, he saved about $500. Nice.
Now let’s follow his lead. Small claims court gives us great leverage against bogus billers. Let’s use it!