Illegal Hospital Billing: Another Reason You Need a Personal Injury Attorney
POSTED BY Scott O’Sullivan
February 22, 2023
Personal Injury Law
Denver’s hospitals are doing amazingly well. Especially considering the fact that many are supposed to be “non-profits.” The Colorado Department of Health Care Policy & Financing recently reported, “Colorado Hospital Profits Among Nation’s Highest for Third Consecutive Year.”
And LawWeekColorado.com reported, “New analyses of Colorado hospital costs, prices and profits show overall hospital patient revenues have grown faster than operating expenses, leading to growing profits and margins.”
Meanwhile, how is your healthcare bill looking? Unbearable? Mine too. Many Coloradans pay a huge percentage of their annual income to health insurance premiums. Why do we do that? So that when a health emergency strikes – such as a car or motorcycle crash – we are protected from financial ruin.
So, how would you feel if you knew that hospitals are doing some nasty billing jiu-jitsu on accident victims who show up for care? Colorado hospitals are literally taking steps to get more money out of a victim’s settlement than they are owed.
Seriously: If you have been the victim of a car or motorcycle accident in Colorado, you need to at least talk to a personal injury lawyer. The consultation is free, and you might find out that the “friendly” hospital billing personnel are pulling a fast one on you.
Here is how it works.
Victims of accidents enter emergency rooms and try to give the hospital their own health insurance information to cover their bills. Hospitals are saying: “Oh, you shouldn’t have to pay for this. You were the victim. Give us the other driver’s insurance information and we will bill them instead.”
Hospitals cannot do anything with the other driver’s insurance. Nothing. Nada.
So, why did they ask for it? They are pulling a fast one.
Why illegal hospital billing happens
Here’s what they’re really doing: Hospitals are avoiding billing until the victims settle their lawsuits. Then, hospitals then get their fees paid out of the settlement. It’s complicated, but here’s why they are doing this:
Hospitals have agreements with health insurance providers that allow them to be paid only a percentage of a full bill, usually .50 or .60 cents on the dollar. They would certainly like to make more than that.
So, instead, as soon as a hospital finds out that there was an accident, their billing department puts a lien on any settlement that the victim receives.
Through the lien, the hospital is trying to get the full bill paid. However, this ends up costing victims a lot more, and victims usually need every dime from a settlement to address ongoing issues as a result of the accident (loss of job, loss of home, other bills).
Essentially, the hospitals are refusing to bill the victim’s health insurance and are instead billing the victim.
Even worse, if the victim receives no compensation for the accident (if, for example the at-fault driver had no insurance), the victim may be forced to pay medical bills that their own medical insurance would have covered!
If you are the victim of an accident and you end up in the emergency room, make sure you provide the hospital with YOUR insurance and tell them specifically: “You must bill my health insurance company for the care that you provide to me.” Make sure you give them a copy of your own health insurance card.
What Are the Steps You Can Take to Prevent Medical Billing Fraud?
When you are admitted to the hospital after a car or motorcycle accident, take the following steps:
Immediately provide the hospital with your health insurance information. Tell them explicitly and in writing that the hospital must bill your healthcare insurance provider. Then, ask for a copy of that signed document. If they try to withhold billing to take advantage of your future legal settlement, you can say that you told them in writing to bill your health insurance company.
Do not give the hospital the other driver’s auto insurance information. They can’t use it to pay your bills (it’s not health insurance; it’s car insurance) and you’re just alerting them to the fact that you were in an accident.
What Else Are Hospitals Doing After Car Accidents in Colorado?
Another improper billing practice that hospitals often employ to make more money off of your care is that they choose to provide treatments that aren’t part of your healthcare plan. Hospitals go outside your network when, very likely, your healthcare plan offers in-network coverage for your treatment. Then you end up paying full price out of your own pocket.
Therefore, when you give a hospital your insurance information, you must explicitly state in writing that you only authorize them to use your healthcare insurance. Here is the language I recommend:
“I am providing my healthcare insurance to [name of hospital] and I only authorize treatment through my healthcare insurance provider’s in-network services. If [name of hospital] chooses to provide out-of-network services in my treatment, then [name of hospital] will be responsible for those costs.”
This practice has become so commonplace that I suggest you share this article with friends and family.
How to Report Medical Billing Fraud
Now, what do you do if you suspect that a hospital is using unethical billing practices in your treatment? I would advise that you handle this in one of two ways:
If you were in a car or motorcycle accident, ask a personal injury attorney to review your case and your medical bills. Colorado personal injury attorneys see these kinds of improper billing practices all the time.
Not only will a good attorney be able to identify unethical billing practices, but they can fight for your legal rights. If a hospital is trying to put a lien on your future legal settlement, you’re going to need an attorney.
If you weren’t in an accident but you’re facing large, confusing medical bills for treatments you received, contact the hospital and insist that they give you an itemized medical bill. Also, demand to know whether the service they provided was in-network or out-of-network for your healthcare insurance.
If you don’t even recognize a doctor’s name on the bill, get clarification. You can also enter medical codes from hospital bills in Google and learn what the codes stand for.
It’s not uncommon for people to discover that they’re being billed for treatments they never received from doctors they never met! If you suspect medical billing fraud, contact the Colorado District Attorney.