In 2014, French underwent a spinal-fusion surgery due to complications from a car accident. She had the surgery because her doctor warned her that even minor trauma, a fall or a trip for example, could cause paralysis. The pain of the recovery was immense but French said that she did not worry about the financial cost. She was confident that her medical insurance company would pay most of the medical costs associated with the surgery and the recovery.
Fast forward three years. French answered a knock on her front door on a Sunday morning to be handed an envelope. The process server handed her papers notifying her that the nonprofit hospital, St. Anthony North Health Campus, where she had the surgery, was suing her for $229,112.13. Before she went into surgery, hospital officials told her that after her medical insurance kicked in she owed $1,336. There's a huge difference in what she was told and what was handed to her on that Sunday morning.
Evidence of Gouging
ELAP services is a company that helps employers reduce the costs of the healthcare offered to their employees. They comprehensively analyze the healthcare costs to evaluate if the billed costs are reasonable. “Our experience is that there is a lot of profiteering going on, and bills that have no rational relationship to the cost of service,” says Steve Kelly, CEO of ELAP Services. “We don't want our clients and families subjected to predatory pricing.”
“Predatory pricing” is a powerful yet fitting word for this situation. According to the evidence submitted during French's trial, the hospital marked-up the spinal-fusion implants themselves by over 500%. The spinal-fusion implants cost the hospital $31,665.05 but they charged French an inflated $197,640. ELAP has also found that hospitals within the same city charge four times as much as their competitors for the same procedure. How is that reasonable? The term “predatory pricing” seems fit—don't you think?
According to Wendy Forbes, a spokesperson for Centura Health, St. Anthony North charges are in the bottom 25% in the hospital community. “She [French] had a very complicated surgery with major complications due to her personal, pre-existing health conditions. The charges were fair and reasonable and grounded in the fundamental economics of health care under our current system.” So her defense of the gouging is essentially, “everyone else is doing it so we do too!” Does this not speak to a larger problem across American healthcare? Hospitals are putting their patients at the bottom of their lists of things to care about.
The debate starts with what is “reasonable” and what is not. How do hospitals and insurance companies come up with their pricing? ELAP is doing their best to help individuals and families gouged by hospitals. French feels that the hospital was using her as a guinea pig to fight ELAP. Hospitals feel threatened that the people they are ripping off are getting help.
Thankfully, an Adams County jury found on the side of French. They found that the hospital bills were unreasonable. Because the jury sided with French, this opens the door to employers having more of a say in the rising health care costs. This would be a huge shift in healthcare. Would this force a decrease in how much healthcare costs? Would this cause more of a rift in healthcare?
Will There Be Change?
French's case is the first case out of over 700,00 billing disputes handled by ELAP that went in front of the jury. Will there be a change? Will there be a shift in how people are charged for their procedures? We see people all the time where insurance companies or hospitals try to overcharge for their services.
George Tait Law and its lawyers are not representing any of the parties mentioned in this article at the time the article was posted. Our information source is cited in the article. If you were involved in this incident or a similar incident and have questions about your rights and options, call us or another reputable law firm.