Ethan Rhodes
Hospitals often bill uninsured patients significantly more than insured patients for the same services. Uninsured patients are among the most vulnerable members of society, and many cannot afford legal representation to dispute these charges. While individuals can sue a hospital for excessive emergency room charges, there are several steps one can take to prevent and handle emergency room overcharges. These include requesting an itemized statement of the charges, asking the billing department for adjustments, and negotiating with the hospital to reduce the payment.
| Characteristics | Values |
|---|---|
| Uninsured patients | Often charged significantly more than insured patients for the same services |
| Hospitals required to disclose pricing | Under a new transparency regulation, hospitals must post their pricing online |
| Itemized bill | Ask the hospital for an itemized bill with all billing codes listed |
| Research actual price | Use tools to find the hospital's pricing file and verify that you were charged correctly |
| Compare prices | Compare prices at Healthcare Bluebook and Clear Health Costs |
| Out-of-network services | Refuse to pay for inappropriate care; many patients are unaware they can be charged for non-urgent care at an in-network hospital |
| Insurance | Check your insurance coverage and call the insurer's customer service line if your plan isn't covering something you thought it would |
| Patient consent | Patients are not obligated to pay for services they did not consent to or receive |
| Negotiation | Have a patient advocate negotiate with the hospital to reduce the payment |
| Legal representation | Seek legal representation to file a lawsuit against the hospital |
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What You'll Learn
Request an itemized bill and identify errors
Requesting an itemized bill and identifying errors is a crucial step in challenging hospital overcharging and seeking legal recourse. Here's a detailed guide on this process:
Understanding Your Rights
Before requesting an itemized bill, it's important to understand your rights as a patient. You have the right to receive a detailed breakdown of the charges and to dispute any errors or overcharges. Additionally, if you are facing overcharging for emergency room visits, it's important to know that patients are not obligated to pay for services they did not consent to or receive. Hospitals are required by law to charge uninsured individuals the same rate as insured patients for the same services.
Making the Request
Contact the hospital's billing department and request an itemized statement of your charges. This statement should include a list of all the services, procedures, and items you were billed for, along with the corresponding dates and pricing. You can also ask for an explanation of any billing codes or terminology that you don't understand. It is within your rights to request this information, and hospitals are obligated to provide transparency in their billing practices.
Identifying Errors and Discrepancies
Once you receive the itemized bill, carefully review each item. Look for any duplicate charges, incorrect dates, or services that you did not receive. Compare the billed items with your records, including any discharge paperwork or medication lists. Keep in mind that medical bills often contain errors, so be vigilant in identifying any discrepancies. Additionally, research the standard prices for the procedures and services you received. Tools like the Hospital Price Files Finder or state-specific tools, such as the Colorado Hospital Price Finder, can help you verify if the charges are in line with the hospital's posted pricing.
Documenting the Evidence
As you identify errors or discrepancies, thoroughly document the evidence. Highlight or mark the questionable charges on your itemized bill and make notes about why you believe each charge is incorrect. If possible, gather supporting documentation, such as receipts, insurance explanations of benefits (EOBs), or even screenshots of prices for similar services at nearby hospitals. Building a clear and organized case file will be crucial if you decide to dispute the charges or pursue legal action.
Seeking Support
If you identify errors or overcharges, consider seeking support from a patient advocate or a medical billing expert. They can help you navigate the complex billing system and negotiate with the hospital on your behalf. Additionally, consulting with a legal professional, such as a medical malpractice attorney, can help you understand your legal options and determine if you have a valid case for a lawsuit. They can guide you through the process of challenging the hospital's billing practices and seeking compensation for any financial harm caused by overcharging.
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Compare prices with other hospitals
Comparing prices with other hospitals can help you determine if you have been overcharged and strengthen your case if you decide to sue a hospital for overcharging.
Since 2015, hospitals have been required to post their pricing online, thanks to a transparency regulation implemented by the Trump administration. However, there is currently no uniformity in how hospitals make this information available on the internet. Some hospitals have buried the information on their websites, and the thousands of entries have codes and descriptions that are challenging to decipher.
Despite this, you can use online tools to compare hospital prices. FAIR Health, for example, provides cost information for commonly performed hospital procedures for hospitals in Westchester, Syracuse, Albany, and Buffalo, New York. Healthcare Bluebook and Clear Health Costs are two other online tools that allow you to compare prices. Additionally, the Healthcare Price Tool reviews historical billing records to enable you to price-compare healthcare options in your area.
You can also save screenshots of prices for nearby hospitals, look up the cash price, or compare your charges with the transparent prices at the Surgery Center of Oklahoma and Texas Free Market Surgery. If you have insurance, you can check your explanation of benefits (EOB) to determine if the service or procedure is covered.
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Address out-of-network services
It is important to note that 57% of Americans receive unexpected bills due to being unaware that they can be charged out-of-network fees at an in-network hospital for non-urgent care. If you have received unnecessary care or had an avoidable complication, you can demand that you not be charged for these services.
If you have insurance, check your explanation of benefits (EOB) to determine if the service or procedure is covered. Call your insurer’s customer service line if your health plan isn’t covering something you thought would be covered. The No Surprises Act is a federal law that went into effect on January 1, 2022, and it protects you from unexpected out-of-network medical bills. Under this law, you can dispute your bill if it’s at least $400 more than the estimate.
If you used health insurance, you don't qualify to dispute a bill. However, you should submit a complaint if you received care on or after January 1, 2022, and:
- You received an out-of-network bill for a visit to the emergency room or an in-network facility.
- You already paid more than in-network rates for a visit to the emergency room or an in-network facility.
- Your provider didn’t follow the rules around notice and consent.
- Your insurer decided not to pay part or all of a claim, and you think this decision violates the No Surprises Act.
If you think the decision violates the No Surprises Act, appeal your bill and follow the process described in your plan's documents and denial notices. You can also submit a complaint to the No Surprises Help Desk.
If you did not have health insurance, you may have been subjected to emergency room overcharges. Hospitals are required to charge uninsured individuals the same rate as insured individuals. However, hospitals often ignore this provision and overcharge patients for ER procedures that were not consented to or provided during the visit. Under the law, patients are only obligated to pay the rate of emergency room charges for services if they consented to receiving the services and actually received them.
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Identify unnecessary care or avoidable complications
Unnecessary care or avoidable complications are common reasons why patients may choose to sue a hospital for overcharging. Patients may receive bills for unnecessary care or avoidable complications, which can result in unexpected charges. Patients can demand that they are not charged for these services and can negotiate using price checking platforms such as Turquoise Health, Healthcare Bluebook, MDsave, and Clear Health Costs.
It is important to identify whether the care received was necessary and whether any complications could have been avoided. This can involve reviewing medical records and seeking a second opinion. Patients should also be aware of their rights and the regulations that hospitals are required to follow. For example, hospitals are required to post their pricing online and charge patients the same rate, regardless of insurance status.
If patients believe they have received unnecessary care or experienced avoidable complications, they can take several steps to address the issue. Firstly, patients can request an itemized bill with specific billing codes and compare it to the hospital's posted prices to identify any discrepancies. They can also research the prices of nearby hospitals to determine if they have been overcharged. If patients identify errors or discrepancies in their billing, they should immediately dispute them with the hospital.
Additionally, patients can address out-of-network charges, which can result in unexpected bills. Patients can check their insurance coverage and explanation of benefits to understand what is covered by their plan. If patients have insurance through their employer, they can also seek assistance from their Human Resources department.
If patients believe they have been unfairly charged for unnecessary care or avoidable complications, they can contact the hospital's billing department to request adjustments. Patients can also negotiate with the hospital to reduce the payment amount owed. If these steps do not resolve the issue, patients can consider seeking legal assistance and filing a lawsuit against the hospital.
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Understand your rights as an uninsured patient
Being uninsured does not mean you are without protection. If you have been treated in an emergency room at a hospital and you did not have health insurance, you may have been subjected to emergency room overcharges. Hospitals often bill uninsured patients significantly more than insured patients for the same services. However, a hospital is required to charge an individual without insurance the same rate as an insured individual. Hospitals often ignore this provision and engage in medical overbilling by charging patients excessively for ER procedures that were not consented to or provided during the ER visit. Under the law, patients are only obligated to pay the rate of emergency room charges for services if they consented to receiving the services and received them.
You can take several steps to prevent and handle emergency room overcharges, including requesting an itemized statement of the charges to see what you were treated for. You can also ask the billing department for adjustments for anything you did not approve, and have a patient advocate negotiate with the hospital to reduce the payment and amount owed. You can also save screenshots of prices for nearby hospitals, look up the cash price, or compare prices at Healthcare Bluebook and Clear Health Costs. For surgical procedures, you can also compare your charges with the transparent prices at The Surgery Center of Oklahoma and Texas Free Market Surgery. You can then use those prices to negotiate.
Many patients are unaware that they can receive an out-of-network charge at an in-network hospital for non-urgent care, resulting in unexpected bills. If you received unnecessary care or had an avoidable complication, demand that you not be charged for these services. You can also research the actual price posted by the hospital. Use tools like the Hospital Price Files Finder to find the hospital's pricing file and verify that you were charged correctly. If you cannot confirm the price is correct, call or write to the hospital and dispute the bill. With no written agreement, you have no legal obligation to pay. If debt collectors are calling and insisting on payment for an unfair bill, demand that they provide you with the contractual agreement in which you are obligated to pay.
Federal and state laws require certain hospitals to provide some level of charity care, but not all eligible patients benefit from these programs. Charity care costs represent a small share of operating expenses at many hospitals. Research suggests that gaining health coverage improves the affordability of care and financial security among the low-income population. Multiple studies of the ACA found declines in trouble paying medical bills and reductions in medical debt in expansion states relative to non-expansion states. Uninsured adults are more likely to face negative consequences due to health care debt, such as using up savings, having difficulty paying other living expenses, or borrowing money.
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Frequently asked questions
Yes, you can sue a hospital for excessive emergency room charges that you did not consent to or receive. Hospitals often bill uninsured patients significantly more than insured patients for the same services.
Before suing a hospital for overcharging, you should request an itemized statement of the charges to see what you were actually treated for. You can then ask the billing department for adjustments for anything you did not approve or receive. You can also have a patient advocate negotiate with the hospital to reduce the payment and the amount owed.
Emergency room overcharges are common for uninsured patients. Hospitals often bill uninsured patients much more than insured patients, and may even sue them for high undiscounted chargemaster rates. Since many uninsured patients cannot afford legal representation, hospitals may secure default judgments and add on attorney's fees and interest.
