After Lisa French’s doctors warned her she could be paralyzed if she tripped or fell on her back, the hospital told the Colorado resident she would have to pay around $1,337 out of pocket for two procedures.
Money was tight, so Ms French and her husband used all the money from their emergency fund – $1,000 – to help cover most of the expected post-insurance costs for back surgeries , according to his lawyer.
So when she received the bill from St. Anthony North Health Campus in 2014, Ms. French thought it was a mistake: The hospital had billed her $303,709 — and she owed more than $229,000 of her poached.
As part of the forms she filled out at the non-profit Westminster Hospital in Colorado, operated by Centura Health, Ms French had unknowingly signed up to pay all charges associated with ‘chargemaster’ rates then hospital secrets—a master price list that determined the posted prices for everything the hospital did.
Years after Ms French argued she was never told about the chargemaster and embroiled in a years-long legal battle with the hospital, the Colorado Supreme Court ruled in her favor this week, saying that ‘She wasn’t required to pay the rest of the massive bill because she didn’t agree to the hospital’s secret pricing.
State Supreme Court Justice Richard Gabriel wrote in an opinion on Monday that Centura Health’s argument that Ms. French was required to pay “all hospital charges” was dismissed because the “long-established principles of contract law” showed the 60-year-old never agreed to pay the chargemaster rate.
“She certainly could not consent to terms of which she had no knowledge and which were never disclosed to her,” Gabriel wrote in the notice.
State and federal laws have since been passed requiring hospitals to make their charging prices public. None of the laws were in place when Ms French had her surgeries in 2014, according to the Denver Postthe first to announce the news.
Gabriel lambasted the healthcare industry’s predatory billing practices in this week’s advisory, noting that “hospital billing officials have become increasingly arbitrary and, over time, have lost all direct link to actual hospital costs, rather reflecting inflated rates set to produce a targeted amount. profit for hospitals after taking into account discounts negotiated with private and government insurers.
A spokesperson for Centura Health did not immediately respond to a request for comment Thursday.
Ted Lavender, Ms French’s attorney, said The Washington Post that his case reflects how some hospitals make “no effort to provide meaningful information to the patient and the cost of a procedure.”
About $197,000 of the total bill of $303,709 came from 13 pieces of spinal hardware that were marked up significantly from their estimated cost of about $31,000, Lavender said.
“It’s not unlike that of ordinary Americans who go to hospitals with a medical need and sign documents placed in front of them to create a contract on the medical treatment that is about to be rendered,” Mr. lavender. “That was very telling in the case of Mrs. French.”
Most U.S. hospitals are still not complying with federal regulations requiring medical centers to post their prices online for patients to review, according to a 2021 report from patient advocates.
The report, which examined the websites of 500 of the roughly 6,000 hospitals subject to the rule, found that 471 of the hospitals did not fully display the prices they charge patients and the rates they have negotiated with providers. insurers. The federal price transparency rules went into effect on January 1, 2021.
Ongoing complications from a car accident forced Ms. French to look into spinal fusion surgery near her home in Thornton, Colorado, located about 20 miles from downtown Denver. Ms French, a mother of five with type 2 diabetes, is struggling financially to keep her family afloat, especially as her husband cannot work due to a disability, reported the Denver Post.
When she went to the hospital, Ms French was quoted the pre-surgery price of $1,337 – a figure based on her health insurance provider being in-network with the hospital. But when a hospital employee mistakenly gave Ms. French the estimate after misreading her insurance card, Centura Health did not notify Ms. French of the change, a lawsuit alleges.
As an office clerk at a trucking company, Ms. French’s insurance plan was tied to ELAP Services, a company based in Wayne, Pa., which checks hospital bills to assess the value of medical services provided , said Mr. Lavender. After her surgeries were completed, ELAP advised French’s employing insurer not to pay her hospital bill of approximately $229,000, alleging that she had been grossly overbilled. ELAP and the insurer agreed to pay approximately $74,000. Centura Health disagreed with ELAP and sued Ms. French for the remainder of the bill in 2017.
“It was shocking to her,” said Mr. Lavender, an Atlanta-based attorney who was appointed by ELAP to represent French. The post office.
Wendy Forbes, a spokesperson for Centura Health, told local media at the time that the increase in the price of the surgeries was “fair, reasonable and justified” because Ms French underwent what she described as “an operation very complicated with major complications due to his personal situation”. , pre-existing health conditions.
Ms. French told the Denver Post in 2018 that “it was all very stressful and tiring.”
“I always felt like the hospital was using me as a guinea pig to fight this company that was helping people stay out of scams,” she said.
In 2018, a jury ruled that even though Ms French had breached her contract, she only owed the hospital an additional $767. When Centura Health took the case to the Colorado Court of Appeals in 2020, the three-judge panel overturned the jury’s decision, saying the term “all charges” in French’s contract with the hospital was “sufficiently defined”.
“Hospitals cannot always accurately predict the services a patient will ultimately need,” Court of Appeals Judge Terry Fox wrote in a May 2020 opinion.
The state Supreme Court, however, was skeptical of the appeals court during oral arguments in March.
“When I bring my car in for service, they don’t know what’s wrong either,” Gabriel said during oral argument, according to Colorado Politics. “But they’re investigating and they call me and say you need a new this or a new that and that’s what it will cost.”
Michael T McConnell, a lawyer for Centura Health, responded to the high court saying, “Your mechanic is not a doctor.”
“Obviously you think that’s the way it should be,” McConnell said in March. “It’s not like that.”
Mr McConnell argued in March that the hospital should not be tasked with understanding “the patient’s insurance better than the patient”.
But the state Supreme Court was unconvinced, ruling Monday that French was not liable for the entire bill and would only be required to pay the hospital the additional $767 from the 2018 jury verdict. .
“If a charge for hospital services is not included in a hospital-patient contract, then we believe a jury is fully capable of determining the reasonable value of the services provided,” Gabriel wrote.
When Mr. Lavender called Ms. French to tell her about the Colorado Supreme Court decision, the lawyer said The post officehis client was relieved and “very happy” that the years-long legal fight over the alleged six-figure back surgery price was finally over.
“It’s been a long road,” he said, “but she’s happy with the result.”