Egregious Billing Practices by USA Health Care Organizations

Taking Surprise Medical Bills To Court Under the Theory of “Mutual Assent”

Consumers are increasingly vulnerable to... so-called balance bills, which represent the difference between what insurers pay and hospitals’ list prices. List prices can be several times higher than what they accept from Medicare or in-network insurers.

Congress is considering bipartisan legislation to limit balance billing. But some legal scholars say that patients should already be protected against some of the highest, surprise charges under long-standing conventions of contract law.

That’s because contract law rests on the centuries-old concept of “mutual assent,” in which both sides agree to a price before services are rendered, said Barak Richman, a law professor at Duke University.

Thus, many states require, and consumers expect, written estimates for a range of services before the work is done — whether by mechanics and plumbers or lawyers and financial planners.

But patients rarely know upfront how much their medical care will cost, and hospitals generally provide little or no information.

While consumers are obligated to pay something, the question is how much? Hospitals generally bill out-of-network care at list prices, their highest charges.

Without an explicit price upfront, contract law would require medical providers to charge only “average or market prices,” Richman said.

In several recent cases, for example in New York and Colorado, courts have stepped in to mediate cases where a patient received a big balance bill from an out-of-network provider. They ordered hospitals to accept amounts far closer to what they agree to from in-network private insurers or Medicare.

I strongly believe congress should pass a law outlawing the existing practices. And it is good to know the most egregious, and increasingly common, practices of the USA hospitals are already illegal. If you state hasn't already taken hospitals using such practices to court and required refunding all ill gotten gains, contact your attorney general to make sure they do so. And contact you state legislators to make sure they act also. Several states have been much more concerned with protecting their citizens from being abused by large health care providers but most states have not.

The existing practices are unethical and it is unconscionable that our elected representatives have allowed such egregious practices to continue and even become more common.

Related: Democrats and Republicans Have Failed the USA on Health Care for Decades (2015) - USA Health Care System Remains Broken, Neglected (2011) - The USA Should be Ashamed of Who We have Elected - Decades of Failure by Those Responsible for USA Health Care System Needs to be Addressed (2012)