It’s important to have a game plan for medical bills, and the game plan should probably not involve suing the hospital as a preemptive strike. That is precisely what occurred in Pitell v. King County Public Hospital, No. 767720-8-1 (Court of Appeals of Washington, Div., 1, August 13, 2018).
Steven Pittell had over $50,000 in his bank account but was uninsured and ineligible for Medicare and Medicaid, when he was admitted to the hospital. He signed a consent form that stated in part:
I agree, whether I sign as a representative or as a patient, that in consideration of the service to be rendered to the patient, I agree to be personally responsible for the balance due after any applicable insurance payments.
After Mr. Pittell was discharged, he was billed over $32,000 for the medical services provided to him. His application for charity care was denied due to his bank balances. The hospital did reduce the charge by 20% to approximately $25,800, because Pittell was uninsured. A majority of the five largest commercial insurers would have paid a higher rate on the patient’s bill.
Rather than paying the bill, Pittell sued the hospital on behalf of a class of similiarly situated patients, claiming that the consent form was unenforceable because the hospital failed to disclose its chargemaster (i.e., the hospital’s standard price list for hospital services) at the time of treatment.
The trial court rejected this argument, dismissing Pittell’s case and issuing a judgment requiring him to pay the amount of the discounted bill, plus attorney’s fees and costs. The Court of Appeals of Washington affirmed.
Had Mr. Pittell purchased insurance on the exchange, he would have had coverage. Even if he did not, an attorney could advise him of important options, such as filing for bankruptcy, whether any federal benefits he was receiving (such as Social Security, the Veteran’s Improved pension) or a military or civil service pension or salary are protected against garnishment under federal law. The attorney could also have negotiated a reasonable payment plan. If for some reason, the bill was already covered to some extent by Medicare, Medicaid or other health insurance, an attorney could help obtain evidence of other payments from the medical provider, review the bill, determine whether the amounts paid were accurate, and require the hospital to reduce the amount outstanding by the amount of any prior payments. If there is some insurance coverage, an attorney can also advise whether your state prohibit balance billing.
For more information about the circumstances under which federal benefits are protected, see my blog, When Are My Federal Benefits Protected?.
Questions? Let Jane know.
Jane Fearn-Zimmer is a shareholder in the Elder and Disability Law, Taxation, and Trusts and Estates Groups. She dedicates her practice to serving clients in the areas of elder and disability law, special needs planning, asset protection, tax and estate planning and estate administration. She also serves as Chair of the Elder & Disability Law section of the NJSBA.