Medical Care Costs are Not Created Equal
By Marcy B. Spitz, Esq.
In any personal injury case, there is always the possibility of a medical lien that might exist for charges that are related to the injury, accident, or illness. Not only does the charge need to be related to the injury, but it will now be transparent due to federal law requiring how much the hospital negotiated with the insurer to charge the patient for all medical procedures.
Beginning in January 2021, nearly all hospitals must make their prices public after the Centers for Medicare & Medicaid Services, along with the Department of Labor and the Department of the Treasury issued a historic final rule on price transparency. The U.S. has approximately 6,000 hospitals that must reveal the secret rates they negotiated with insurers for a range of procedures. This change is important to all participants in a health plan, whether they are consumers, or, personal injury attorneys that are tasked with resolving medical liens on behalf of their clients.
Why is this important to you as an attorney? The cost of a C-Section during birth can range from $6,241 to $60,584. This underscores how widely the prices can vary. Medical providers will often base pricing on the type of insurance you carry. For example, Medicare is strict in its reimbursement for a procedure and would fall on the lower end of that range for the C-section while a provider may attempt to bill a private plan at the higher end of the spectrum. This payment information will provide some leverage in negotiating any liens on personal injury cases and should be employed when pursuing a reduction on the lien.
Not all plans charge evenly or equitably. These differences require you to examine the cost of these charges based on the healthcare entity that is covering the care for your client. Commercial plans, Medicare, and Medicaid plans will all vary significantly. A major heart procedure in a complex patient was found to be $89,752 for seven Medicare insurers while commercial insurers were charged $425,945 and three out-of-network insurers were charged $515,697 for the same procedure. Be cognizant of this when negotiating the lien with the insurer and use this to your advantage.
The disclosure and disparity in medical costs based on who is providing coverage will be helpful in analyzing the medical liens for your cases.
MASSIVE can answer your questions on these charges and handle all your lien resolution needs. Contact our experienced and dedicated lien resolution team today at (833) 466-2774 or at [email protected] to learn how our services can work to get a bigger recovery for both you and your clients.