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Monday, October 10, 2016

Ind. Decisions - "Uninsured may gain route to challenge health care prices"

The Supreme Court's decision not to grant transfer in the case of Parkview Hospital, Inc. v. Thomas E. Frost, et al., about which Niki Kelly of the FWJG reported on October 6th, is the subject of this story today in the NWI Times, reported by Dan Carden. Some quotes:

Uninsured Hoosiers someday may be entitled to receive hospital care at the same discounted prices insurance companies pay on behalf of their customers.

The Indiana Supreme Court last week appeared to ignore its own precedent, and opened the door for a northeast Indiana man to challenge the reasonableness of health care pricing by presenting evidence of far lower rates paid by insured patients for identical services.

Thomas Frost, who racked up $629,386.50 in medical bills following a 2013 motorcycle accident, does not dispute that he owes Fort Wayne’s Parkview Hospital for his care.

But Frost claims, under Indiana law, he has a right to learn whether his bill, as an uninsured patient, exceeds the payment the hospital would accept from a patient whose charges are paid by an insurance company or the government.

In a 2-1 decision, the Indiana Court of Appeals sided with Frost in March and authorized him to seek hospital billing records to determine how his charges compare to those of insured patients.

With that information, Frost potentially could reduce his bill under the Indiana Hospital Lien Act, which authorizes circuit courts to evaluate the reasonableness of a hospital patient’s charges.

In a somewhat surprising move, the Supreme Court on Oct. 3 declined, 3-2, to set aside that appellate court ruling and decide Frost’s case itself. * * *

That outcome seems to undermine a 2012 Supreme Court decision that affirmed the practice of health pricing secrecy.

In Allen v. Clarian, an unanimous high court ruled 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.

The decision terminated a potential class-action lawsuit brought by uninsured Hoosiers who believed 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.

Writing for the court in that case, Rucker said “a hospital’s chargemaster rates serve as the basis for its pricing,” regardless of whether the prices reflect the actual cost of hospital goods or services.

ILB: The ILB referenced the 2012 case ("Readers may remember an earlier, similar case from 2012 where the Supreme Court...") in this September 6th post, following the oral argument in Parkview. For more, see this March 21, 2016 ILB post, which points to four posts from 2012 on the earlier case.

Posted by Marcia Oddi on October 10, 2016 12:22 PM
Posted to Ind. App.Ct. Decisions | Ind. Sup.Ct. Decisions