No Rhyme or Reason in Hospital Billing

May 2, 2012 | Crandall & Pera Law
No Rhyme or Reason in Hospital Billing

Patients go to hospitals with the expectation to get better, not to be buried with exorbitant hospital bills for years to come. The latter, however, is becoming more and more of a reality; hospital charges are all over the map, according to a new study reported recently in the Archives of Internal Medicine.

The New York Times recently highlighted this story when an insured California man spent four days admitted in a hospital and was subsequently charged $59,283 – for an appendectomy. This amount is six times the fair price for performing an appendectomy in Northern California, according to the Healthcare Blue Book, and the cases only get more extreme from there; one patient was charged a staggering $182,955 for the routine surgery, and patients were given similar discrepancies in prices for a number of other procedures.

“There’s no rhyme or reason for how patients are charged or how hospitals come up with charges,” said Dr. Renee Y. Hsia, the study’s lead author and an assistant professor of emergency medicine at the University of California. “There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product.”

Practical advice is offered to consumers for dealing with these out-of-control pricing practices that are not limited to the state of California, including: learning which hospitals are in their insurance network, obtaining an explanation of benefits regarding their insurance coverage and contacting the hospital and doctor for pricing estimates beforehand. Read the complete details here:

The Confusion of Hospital Pricing

Steve Crandall, a top ranked medical malpractice attorney, believes a key player is responsible for the problem of overbilling patients: the medical insurance industry, who dictate exactly what procedures they will pay for and how much they are willing to pay for them.

As reimbursements paid to hospitals shrink each year, there is an increased pressure to admit and discharge more overbilled patients in order to maintain profit and recover the shortfall.

“Without any laws to protect the patient or the hospitals, the insurance industry is free to charge more premiums and provide fewer benefits to the insured and the hospitals that care for them,” says Crandall.

If you believe you are being overcharged for your procedures, or if you have any questions about medical malpractice in Ohio and Kentucky, please contact Steve Crandall.