This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.
Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..
Contributed by Eric Dreyfus, Appex Benefits
October 06, 2016 1:03 AM
Court won’t take Parkview rate suit
Hospital must reveal costs, discounts
NIKI KELLY | The Journal Gazette
INDIANAPOLIS – Parkview Hospital will have to release information in a local lawsuit about charges and discounts it provides to insured patients.
That’s because the Indiana Supreme Court decided this week not to take the case in question. The leaves in place a trial court and Indiana Court of Appeals decision in favor of Thomas Frost, who was catastrophically injured in a truck-motorcycle crash and taken by air to Parkview in October 2013.
The court heard oral arguments last month but ultimately voted 3-2 not to take the case.
Chief Justice Loretta Rush, along with Justices Steven David and Robert Rucker rejected the case while Justices Mark Massa and Geoffrey Slaughter would have taken it.
Frost’s total bill was more than $625,000, and he did not have medical insurance.
He is disputing the reasonableness of the charges Parkview has sought under the Indiana Hospital Lien Act. His attorneys asked for information about discounts provided to patients who either had private health insurance or who are covered by government health care programs such as Medicaid and Medicare.
But Parkview blocked the maneuver and asked the Indiana Supreme Court to step in.
Frost received a settlement from the accident that Parkview attorneys said would still leave him with 20 percent of the money after attorneys fees and medical bills were paid.
A billing expert hired by Frost has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case.
Frost’s attorneys argued that rates from the chargemaster – the official list of charges for all procedures, services and goods provided by a hospital – aren’t intended to be paid. They are simply a starting point for negotiation between the hospital and insurance company.
It appears there was no negotiation or discount in the Frost case, possibly because there is an injury settlement.
ADDITIONAL READING COURTESY OF MOLLY MULEBRIAR’S REFERENCE LIBRARY
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