Protecting patients from overcharges |  Opinion

Protecting patients from overcharges | Opinion







Lisa French


Colorado has taken a significant step to protect patients from the predatory American health-care system. On Wednesday, Gov. Jared Polis signed a bill shielding state healthcare consumers from hospital overcharging, which bankrupts approximately 50,000 Coloradans each year. The law prevents hospitals from sending consumers’ medical debt to collections agencies if hospitals don’t comply with federal law to post their prices. It gives patients peace of mind that a trip to the hospital won’t result in financial ruin, helping put an end to health-care over-billing horror stories like mine.

In 2014, I was injured in a serious car accident. My doctors warned me that a mere trip and fall could leave me paralyzed, and they recommended spinal-fusion surgery. I was worried about the price of this procedure, but I had good insurance through my job, and the hospital said it would cost me $1,337 out-of-pocket. In June of that year, I had successful surgery at a hospital in Westminster.

So imagine my surprise when weeks later, I received a bill for more than $300,000. I thought the charge must be a mistake, but it turned out the hospital had misread my insurance, and I wasn’t covered. I am the sole earner in my family, and I have five children, so there was no way I could ever dream of paying this bill. Even coming up with $1,000 of the $1,337 that I thought I owed exhausted my emergency savings. (My employer insurance also paid the hospital more $70,000, partly funded through my years of monthly premiums).

When I couldn’t pay the balance of this bill, the hospital sued me to collect it. This action threatened my credit score, my assets and my wages. On behalf of patients across the state and country who have endured aggressive hospital billing and ruinous lawsuits for decades, I decided to fight this bill in court. After an eight-year battle, the Colorado Supreme Court finally ruled in my favor last month, erasing this massive debt.

The court stated that “under long-settled principles of contract law,” I was not responsible for this bill. “She assuredly could not assent to terms about which she had no knowledge and which were never disclosed to her,” wrote State Supreme Court Justice Richard Gabriel.

However, in the bizarre and opaque American health-care system, almost no one can assent to their terms of care. During the court proceedings, I requested the hospital reveal the prices behind my bill, but it refused, claiming price information is “proprietary and a trade secret.”

When I finally got access to my itemized bill details, I understood why the hospital didn’t want its prices known. It turns out the hospital charged nearly $200,000 for spinal-surgery parts that cost $28,000 — an outrageous up-charge. Needless to say, if I knew my surgery cost $300,000 beforehand, I would have had it elsewhere. Hospitals seemingly hide their prices to make it easier to overcharge patients and pad their profits.

Colorado’s new law prevents patients from having to fight hospital over-billing in court. It stops these bills from reaching collections agencies in the first place if real prices aren’t posted. It will significantly reduce health-care bill-induced financial devastation in the state.

The law will also help usher in a pro-patient, pro-consumer health-care system by encouraging hospital price transparency. In January 2021, a federal hospital price transparency rule took effect requiring hospitals to publish their actual prices by insurance plan. This information allows health-care consumers to enjoy financial certainty before care and avoid price gouging hospitals in favor of high-value alternatives.

However, a recent study by PatientRightsAdvocate.org finds that only 14.3% of hospitals nationwide and 1-in-17 examined in Colorado are complying with the law. I still can’t access prices at the hospital where I had my surgery. The new Colorado law will significantly boost hospital compliance with this rule because it threatens the revenues of those that don’t.

The law’s long-term benefit of helping unleash a competitive, price-transparent health-care marketplace that empowers consumers and reduces health-care costs may turn out to be even more important than its immediate protection of patients from hidden overcharging. Either way, the law is a body blow against the American healthcare beast.

Lisa French is an office clerk in Henderson.

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