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Monday, March 21, 2016

Ind. Decisions - "Could Indiana Supreme Court take second look at health care pricing"?

Here are snippets from some ILB posts from 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...
Posted in The Indiana Law Blog on December 20, 2012 02:31 PM

Ind. Decisions - More on today's Supreme Court decision on health care costs - With respect to the Supreme Court's decision today in Abby Allen and Walter Moore v. Clarian Health Partners, Inc. (ILB summary here), see this post today from Masson's Blog, which points to the language in the COA opinion stating that...
Posted in The Indiana Law Blog on December 19, 2012 02:53 PM

Ind. Decisions - Supreme Court decides three today including Abby Allen and Walter Moore v. Clarian Health Partners, Inc.
Posted in The Indiana Law Blog on December 19, 2012 10:46 AM

Ind. Courts - "Uninsured patients' lawsuit carries high stakes for area hospitals" [Updated] - Jeff Swiatek of the Indianapolis Star had a long Sunday story about a case set for oral argument on May 10th before the Supreme Court, Abby Allen, et al. v. Clarian Health Partners, Inc. The first ILB entry on this...
Posted in The Indiana Law Blog on April 30, 2012 08:54 AM

These posts came to mind when I read Dan Carden's story this morning in the NWI Times on last Monday's Court of Appeals 2-1 opinion in Parkview Hospital v. Thomas E. Frost by Shirley A. Riggs, his Guardian. Carden's well-worth-reading story begins:
INDIANAPOLIS — Despite a federal mandate that all Americans purchase health insurance, about 1 in 8 Hoosiers still are personally responsible for all the costs of their medical care — including 75,000 Lake County residents, 20,000 in Porter and 15,000 in LaPorte.

But unlike just about every other product or service that individuals regularly buy, where the price is known up-front, health care costs almost always are opaque until the bill, which can be considerable even for the most routine procedures, comes in the mail.

Four years ago, the Indiana Supreme Court affirmed the practice of health pricing secrecy by ruling that a hospital's "chargemaster," its list of undiscounted item and procedure rates billed to uninsured patients, need not be reasonable or even made available for review prior to a patient signing an agreement to pay his or her incurred charges.

That decision terminated a potential class-action lawsuit brought by uninsured Hoosiers who felt they had been overcharged by the state hospital network now known as IU Health, because Indiana law generally requires reasonable charges for services if the cost is not known in advance.

Justice Robert Rucker, a Gary native writing for the unanimous high court, said hospitals are different than, for example, auto body shops, because "in the context of contracts providing for health care services precision concerning price is close to impossible."

More from the story:
Last week, a three-judge panel of the Indiana Court of Appeals strongly suggested the Supreme Court take another look at the reasonableness of hospital charges.

In a 2-1 decision involving a man billed $629,386.50 for care following a motorcycle accident, the appeals court ruled Thomas Frost can challenge the reasonableness of Parkview Hospital's pricing by presenting evidence of far lower rates paid by insured patients for the same services.

Senior Appeals Judge Ezra Friedlander and Chief Appeals Judge Nancy Vaidik, a Porter County native, concluded that under the law Frost has a right to learn whether his bill exceeds the payment the Fort Wayne hospital will accept from an insurance company or the government.

"Frost is not challenging that a debt is due Parkview. Likewise, Frost is not asking a court to impute a reasonable price ... or asking a court to completely disregard Parkview's rates," they write. "Instead, he argues that ... he may challenge the reasonableness of the charges claimed, and is entitled to discovery from Parkview in order to do so."

Even the dissenter, Appeals Judge Edward Najam Jr., said while he sees himself bound by Supreme Court precedent to rule against Frost, he nevertheless believes the high court should reconsider its 2012 ruling.

"There is no discernible or reliable correlation between chargemaster rates and the reasonable value of the health care services provided," Najam said. "In its operation and effect, (the precedent) places health care consumers, including emergency-room patients, at a permanent, take-it-or-leave-it disadvantage."

"Chargemaster rates are not per se reasonable when they are, first, confidential and, second, incomprehensible."

Posted by Marcia Oddi on March 21, 2016 10:32 AM
Posted to Ind. App.Ct. Decisions