Hospital Must Release Information on Pricing Methodology


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.



Hospitals Dismiss Significance Of Chargemaster Prices? #1 MUST READ

Data Shows Large Increases In Hospital Charge Master Rates

Are Hospital Charge Master Rates Unreasonable?

Hospital Charge Master Released to Public

Hospital Charge Master – Basis for Cost Plus Pricing?

Study: Chargemasters still drive up revenue at US hospitals

Hospital Chargemaster Insanity: Heeling the Healers

Hospital Addresses Chargemaster Rates In Response To Time Magazine Story

The Mystery Behind Hospital Charge Masters – Is Pricing Enforceable?

Hospital Must Release Information on Pricing Methodology

Anchoring – What Car Dealers & Hospitals Have In Common

8 Memorable Quotes About Hospital Prices

Billed Charges vs PPO Allowed Charges vs Cost Plus Insurance

Challenge To ‘Balance Billing’ Hits Hospital

Irrational Hospital Pricing

The Redoubtable Chargemaster

BCBS Brings Hospital Contract Negotiations Public

Why Hospitals Bill High

Tough Talk With Hospitals Ends In Missing Person Report

These 10 Hospitals Could Pick Your Pocket Clean

Some Hospitals Charge 1000% Of Medicare Rates? That’s Outrageous!

Hospital Price Gouging Driving Up Healthcare Costs?

Hospital Contracts Made Simple – 120% Method

Cost Plus Insurance To Make Offer To Hospitals?

Ruling: Hospital Bills Should Reflect ‘Reasonable Value’ of Service

Hospital Charges Surge For Common Ailments

1,700 Page Rule Recommends Hospital Pricing Transparency

Hospital Chain Said to Scheme To Inflate Bills

Sutter Health Hospitals Agree To Pay $46 Million To Avoid Airing Secrets?

Hospital Pricing Scam Exposed – Are Health Insurance Companies Complicit – 50% Discount Off Double The Price?

Balance Billing, Chargemaster Pricing & Remedies

Transparency And The Fallacy of Charge Masters

One Hospital Charges $8,000 – Another $38,000

TPA’s Invited To Participate In Lucrative 12% Charge Master Fee

Ah, but it really is the ChargeMaster…………..

Patients Livid At Hospitals For Rewarding Cash Paying Patients With Steep Discounts

Do Hospitals Kick Back Undisclosed Fees to PPO Partners?

Hospital Objection #2

Negotiating With Hospitals Is A Challenge To Logic And Common Sense

How Can A Price That Is Rarely Paid Be Called A “Price?” Hospital Billed Charges Are Make Believe

Amazing Hospital Markups!

Valley Baptist Hospital Announces Addition of Mystery Partner – Cites Cash Flow Needs

AG Finds Clout of Hospitals Drive Costs

Hospital Official Tells Us Cost-Plus is an Illegal Scheme

Price Discrimination By Hospitals

Cost-Plus Hospital Reimbursement Catches On – Employers Embrace Concept Client Tracks Claims To Establish Reserves

If You Like Your Scam, You Can Keep It: the Attack on Out-of-Network Doctors.

Cost Plus / Medicare Benchmarking Continues To Gain Market Acceptance – Are PPO’s Facing Extinction?

Farnsley Responds To Forbes Article

Have PPO Networks Perpetrated The Greatest Heist In American History?

Anchoring Health Care Pricing (See Previous Post)

The PPO Claim Re-Pricing Charade

The Next Innovation In Controlling Healthcare Costs


No, We Won’t Treat You Unless You Pay More!

Healthcare Industry – Redistribution of Profits From Employers

The OPEC OF Healthcare

Top Ten Lessons Of A Reference Based Pricer

Renting Medicare’s Provider Network

Cities Unite To Negotiate Lower Health Care Costs

The Higher The Cost, The More We Make

PPO Touts Higher Discounts

The Employer-Led Health Care Revolution

South Texas Health System Defends 920% Price Markup

Insurance Agent Touts Cost Plus Insurance – Is School District Receiving Fair Value?

Weslaco ISD vs Aetna

PPACA – Game Changer For Health Care Financing

It’s Cheaper To Fly Your Employee To Europe for their Appendectomy

Interesting Trivia for Insurance Consultant Nurds

Cost Plus Insurance Reference Library

Renting Medicare’s Provider Network

Insurance Agent Touts Cost Plus Insurance – Is School District Receiving Fair Value?

The PPACA – Game Changer for Health Care Financing

Costs Are A Function Of What We Agree To Pay