Our Firm sponsored a legal writing contest on the topic of the disparity in medical bills for the uninsured vs. the insured. Here is the winning entry following the question.
Your client is a 25 year old female waitress without health insurance. She falls off of her motorcycle while riding and breaks her femur and has a steel rod and screws inserted to stabilize the fracture. She spends 2 weeks in the hospital and is presented with a $100,000 bill by the hospital. She cannot afford to pay the bill and is being sued by the hospital.
The key issue is reasonableness of the medical bill in light of the fact that the hospital is under a fee services contract with three major health insurers and the fee contract specifies that the hospital agrees to only charge $35,000 to heath insured consumers for the same procedure your client had. What legal arguments can you make on your clients behalf to reduce the amount of the debt your client owes? Bankruptcy is not an option.
The winning response was written by John Burns of Mercer Law School:
My client was involved in an accident where she fell off of her motorcycle and broke her femur bone. She was taken to the hospital where she had a steel rod and screws inserted to stabilize the fracture so it would heal properly. Unfortunately, she had to spend two weeks in the hospital recovering from her surgery, during which time she was unable to work at her job as a waitress. This paper will prove that the hospital overcharged my client and that it is unreasonable for her to pay the full amount of the bill.
Over the two weeks she was hospitalized, she accumulated a hospital bill of $100,000. This posed a problem for her because she did not have any health insurance and could not afford to pay the bill because of her low income. After she was discharged from the hospital she learned that people with health insurance were charged only $35,000 for the exact same procedure. I do not think my client should have to pay $100,000 for a procedure that costs a fraction of that price to other hospital patients.
The first thing I will do for my client is check over her hospital bill from beginning to end and make sure that there are no errors throughout the bill. Errors in hospital bills are common and can dramatically increase the price owed to the hospital. They could have possibly charged her twice for the same thing, or they could have charged her for something she did not receive. By doing this, I can make sure her bill is correct, and if it is not I will notify the hospital immediately of the mistake so they can fix it.
Once I confirm the accuracy of my client’s medical bill, I would research to see if she qualifies for the hospital’s financial assistance program. These programs are mostly for people who do not have medical insurance, are not on Medicare or Medicaid and are not able to pay for their medical bills. To be eligible for these programs she must prove that she does not have the means to pay for such an expensive bill, which she will easily be able to do. Waitresses generally do not get paid a normal salary or minimum wage and make most of their money in tips from patrons of the restaurant. Because her income is potentially very low, she could provide documentation such as her paycheck or tax form to the hospital of her income which could help greatly reduce the cost of her medical bill. If her annual income is 200% lower than the Federal Poverty Guidelines (universityhealth.org), she could possibly get all of her medical expenses taken care of, which is classified as indigent care and is different from Medicare and Medicaid. This is all based on her annual income. The hospital should take into consideration whether or not she is able to pay the bill based on her income.
Regardless of her income level, my client should attempt to negotiate with the hospital to see if they are able to lower the price of her bill. A hospital is more likely to lower a price if you can pay a certain amount at one time. A hospital, as well as my client, would not want to go to court if they both could avoid it, and a good way to do that is to agree on a reasonable price while keeping in mind the original price of the bill as well as the price given to patients with health insurance. If the hospital offered a payment plan to my client as well as a negotiated price for the medical attention she received, it would be more manageable for her to pay her debt and the hospital would be paid for the service they provided. While reading Time Magazine’s “Bitter Pill: Why Medical Bills Are Killing Us” by Steven Brill, I have found that some hospitals charge patients outrageous prices for things such as gauze, oxygen, and daily checkups on their health. These charges can be well over $100 a day and can make a major impact on the price of the final hospital bill. If an insured patient can pay $35,000 for the same surgery and accommodations as my client, why should she have to pay $65,000 more for the same thing? My client and I understand that the hospital and the doctors need to be paid for the work they have done, but to penalize a young girl who is struggling to pay her light bill every month is unfair. Many hospitals across the country give financial aid to low and no income patients, and this should be given to my client.
If the paramedics and the scene of the accident or the emergency room gave any mind-altering medicine such as painkillers to my client before the hospital gave her any forms to sign about any future actions the hospital does, I feel that she could not be held accountable for what they made her sign. For my client to be given a contract by the hospital after the hospital has given her medication that she was under the influence of should play a major part in the validity of the agreement of the contract by my client. Having a person sign a contract when you know they are under the influence of medicine you gave them should make the contract null and void. Generally though, if a person comes in to a hospital, they take that as a sign of consent to help them, regardless of the state of mind they are in upon arrival. Doctors and hospital staff do not always have the time to double check and make sure the patient knows what they are signing.
Many hospitals across the country have clauses in their founding documents that say that they will help a percentage pay medical bills for a percentage of uninsured patients per year, which is generous of the hospital. It shows that they understand that not every person that walks through their doors has the means to pay for the treatment they need. Many patients who do not have health insurance push and plead to get these benefits from their hospitals, but roughly only ten percent of uninsured patients are selected to be helped by the hospital.
In this situation, the issue of decreasing my clients medical bill it difficult to do. Unfortunately, she cannot walk into the hospital or the courtroom and point to a medical related law to help her win her case. There are no laws concerning the price fairness of hospital bills and there is no legal way to make the hospital reduce the cost to patients. The most beneficial thing my client can do is get in contact with a medical billing advocate and get them to negotiate with the hospital. Some advocates claim they can cut the bill to in between 30-50% of the original bill. Not too many people know this, but the medical bills a person receives from a hospital is an invitation to negotiation. Medical billing advocates know how much each procedure costs the hospital and can negotiate with the hospital. Saying that the patient is ready and willing to pay the hospital, but not at the original cost is what gets the negotiation process started. This is what I would advise my client to do in order to get her medical bill to a realistic amount.