« Ind. Decisions - 7th Circuit decides three Indiana cases today | Main | Ind. Law - "How the NRA is larding state constitutions with frivolous, redundant 'right to hunt' amendments" »

Thursday, December 20, 2012

Ind. Decisions - "Supreme Court allows hospital to charge uninsured patients more"

Jeff Swiatek of the Indianapolis Star has a story on yesterday's Supreme Court ruling in Abby Allen and Walter Moore v. Clarian Health Partners, Inc. (ILB summary here, see also here). Some quotes:

The state Supreme Court has reversed an appeals court ruling that let two uninsured patients sue IU Health over hospital bills that were much higher than insured patients were charged for the same care.

The 5-0 decision by the Supreme Court is the first time it's wrestled with the question of whether a hospital can charge uninsured patients more than insured ones.

The decision comes down squarely on the side of IU Health, which argued that the rates it charged the two uninsured patients in 2008 and 2009 were reasonable, even though they were much higher than the rates its insured patients paid.

IU Health had appealed the case to the Supreme Court after the appeals court overturned a Marion County court's dismissal of the case.

The two patients, Abby Allen and Walter Moore, contended that the charges by IU Health (formerly Clarian) were unreasonable and amounted to a breach of contract.

The patients were billed according to IU Health's so-called "chargemaster" rates, which are its unpublished, proprietary rates before insurer-negotiated discounts are applied.

"We align ourselves with those courts that have recognized the uniqueness of the market for health care services delivered by hospitals, and hold that patients' agreement to pay 'the account' in the context of Clarian's contract to provide medical services is not indefinite and refers to Clarian's chargemaster. As a result, we cannot impute a 'reasonable' price term into this contract," the Supreme Court said.

The court cited a scholarly article on the issue that said, "courts have generally tolerated low levels of specificity in medical contracts." * * *

The issue of uninsured-versus-insured billings has become largely moot since new federal guidelines now require hospitals to give discounts to uninsured patients similar to those given to insured ones. The guidelines weren't in effect when the two patients were treated by IU Health.

ILB: Can anyone point me to these "new federal guidelines"?

Posted by Marcia Oddi on December 20, 2012 02:31 PM
Posted to Ind. Sup.Ct. Decisions