Legal Lens: Understanding medical charges and overcharges

Legal Lens

The Brown & Crouppen Legal Lens takes a closer look at everyday legal issues and gives you a better understanding of topics that may affect you.

ST. LOUIS – With COVID still here and flu season around the corner, the topic of medical charges is a popular one.

What are hospital charges or overcharges?

“Most often, it involves someone who is uninsured or who doesn’t qualify for Medicaid or Medicare. So what hospital or emergency room overcharges are is different between someone who is insured pays versus what someone who is uninsured pays,” Andrea McNairy, managing attorney at Brown & Crouppen, said.

“For example, if you hit your head you go to the emergency room, you’re held for observation overnight and they run CT scans or give you other tests and medications. If you are insured you may be charged $7,000; if uninsured, the bill for same services would be like $15,000.”

Do you have to pay or what is the circumstance around that?

“You are responsible for that bill if two criteria are met. One: you consented to those services, and two: you actually received the services,” McNairy said. “Those are both important caveats because what we see in emergency room overbilling or overcharging is being charged for services that were not actually received.”

Can you sue a hospital for any overcharges?

“You can, but a couple of tips before you get to the point. First, if you suspect you are being overcharged, you want to request an itemized statement from the hospital that will outline every service received from the hospital and what you were charged for it. You need to do this if you are insured or uninsured,” McNairy said.

“Second, you want to ask hospital billing for an audit. You can also ask your doctor to look over the itemized bill to make sure you received those services and you can ask the hospital to adjust their billing for any disputed or unconsented charges or something you didn’t actually receive. Finally, if none of those things work, then you can contact an attorney who can help negotiate and reduce and dispute charges on hospital bills and if that doesn’t work then filing a lawsuit is always a possibility and several have been filed over the past few years, including class actions.”

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