One of the most difficult aspects of recovery from an extended illness or serious injury is the mounting hospital bills. If one’s poor medical condition was the result of another’s carelessness or negligence, these bills might be covered by the at-fault party’s insurer. When it comes to Florida personal injury litigation, medical bill reimbursement is often a key part of any case. It should be understood by plaintiffs, however, that whatever financial recovery you obtain in a settlement for prior medical expenses must usually be repaid to the health care provider, hospital, or insurer that initially covered them. Those entities will often argue that they have a “lien” on your personal injury settlement or verdict. These bills or liens can quickly become complicated matters, resulting in a great hassle – and a potentially much smaller sum of money in your pocket – if you don’t deal with them promptly and properly. As a Fort Myers injury lawyer, I’m familiar with the nebulous tactics used by both insurers and providers in these situations, as well as the ever-shifting policy and precedent. At the time of publishing the Florida Supreme Court has recently invalidated the Lee Memorial Hospital Lien law.
When you bring forth an injury lawsuit, your attorney has an ethical obligation to put forth reasonable effort to resolve any disputes between you (the client) and any third-party lienholders (most commonly hospitals, insurers, and health care providers). Where disputes can’t be resolved, we may recommend depositing the disputed funds into the court registry while the case continues. Sometimes, these situations drag on long enough to prompt litigation over unfair/deceptive billing practices, unfair debt collection practices, overcharging, etc. Such action, however, should be a last resort. Ideally, you’re working with a competent civil injury lawyer who will help you resolve these outstanding claims as soon as possible so you can move on with your life. It’s one of the reasons we strongly urge potential clients to hire injury lawyers with proven experience in this particular field of law, rather than jack-of-all-trade law offices.
Disputing Unreasonable Hospital Bills
The issue of unreasonable medical billing has become an increasingly relevant issue in Florida and across the country. It’s gotten so bad that some individuals and families actively seek care in foreign countries. However, that isn’t a realistic option for most folks.
Hospital charges often have little connection to the actual internal costs of services – or even the amounts they typically negotiate with insurers. In most cases, even when patients are asked to pay the bills in full as charged, it goes unpaid. However, plaintiffs injured in third-party liability situations are among those that may get charged the full amount of the care they receive.
What works in the favor of my Fort Myers injury lawyer clients is the fact that patients are allowed to challenge hospital charges that are unreasonable.
The open price term doctrine allows that while contracts for medical services can be binding absent a prior agreement on an exact price, it requires that the price ultimately charged must be reasonable. For example, in the 1995 case of Payne v. Humana Hospital Orange Park, Florida’s 1st District Court of Appeals ruled that patients can’t be bound by unreasonable charges when the agreement is to pay charges in accordance with standard and current rates. In other words: The amount of compensation to which hospitals and health care providers are entitled after a personal injury case is limited to that which is “reasonable.”
Of course, “reasonable” can be a subjective term, and attorneys for hospitals and health care providers know how to twist the facts in their favor. Having an experienced injury attorney on your side who is prepared to challenge inflated costs is an imperative for the sake of obtaining the full and fair compensation to which you’re entitled as a result of your injury.
Assessing the reasonableness of a charge will involve examining:
- The average charges in your community for the same care. This is sometimes called the usual and customary rate.
- The average amount most providers accept as payment in full across the spectrum of all payers. This is sometimes called the average reimbursement rate.
- The internal cost structure of the provider, sometimes referred to as the cost of care.
We can claim unreasonable pricing if the cost cited by the hospital or provider is not aligned with these.
If you have sustained serious personal injuries – or are coping with the death of a loved one – for which you are pursuing a Florida personal injury or wrongful death case, don’t forget to ask your attorney how they plan to help you deal with medical liens. This is important because your attorney’s fee is usually calculated based on the total amount collected; not the net to you. For this reason, It’s imperative that your attorney is knowledgeable and experienced enough to adequately prepare for those challenges – so that when the case is over, it’s well and truly over and you can move on to the next chapter.
If you are injured in Fort Myers, Port Charlotte, Sarasota, Cape Coral, Naples, or Key West, contact Garvin Injury Law at 800.977.7017 for a free initial consultation.
Additional Resources:
Lee Memorial Health System v. Progressive Select Insurance Co., Dec. 20, 2018, Florida Supreme Court
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Do Homeowners’ Insurance Policies Cover Florida Swimming Pool Injuries? April 29, 2022, Fort Myers Injury Lawyer Blog