When it comes to damages in any personal injury lawsuit, one of the most important items is medical bills. It may seem straightforward, but the issue becomes tricky when we consider that not all patients are billed the same way for the same services.
In most states, hospital chargemasters follow complex systems that vary considerably. Managed care organizations will often restrict payments for the services of members, leading to an increase in prices for uninsured patients, who don’t benefit from a provider’s contracts with the plans that negotiate rate differentials. Back in the 1960s, everyone paid the same rate. Not so anymore. For example, a family could be stuck paying a $40,000 hospital bill over the course of a decade, while Medicaid reimburses just $6,000 for that same procedure. Commercial insurers might offer something in between.
So then the question, as outlined in the recent case of Moore v. Mercer, is whether defendants should have to pay more or less, based on the type of insurance the plaintiff has. Is it fair that two defendants liable for the same negligent act pay two vastly different prices? The California Court of Appeal, Third Appellate District, delved into this issue in the Moore case.
According to court records, the defendant admitted he negligently collided with the plaintiff’s vehicle. It was a pretty serious crash that resulted in major consequences for the plaintiff’s health and lifestyle. She was thrown back in her seat and then jerked to one side as the vehicle spun around about 45 degrees. A former restaurant owner, the plaintiff was described by one of her employees as a “queen bee,” always seemingly in multiple places at once, multi-tasking and keeping up with her demanding work and full social life. However, she also had no health insurance.
Following the accident, she could no longer get down on the floor and play with her little boy. She couldn’t work full-time. She could no longer maintain her daily runs. She suffered chronic pain.
She tried numerous times to return to work, but the pain was too much. She tried numerous conservative courses of treatment, trying everything she could to avoid back surgery. She went to physical therapy. She tried aquatic therapy. She moved so that she would have additional family support. She started a new job with more flexible hours. Her pain continued.
Finally, she acquiesced to disc replacement surgery, an extremely difficult procedure with “absolutely zero room for error.” Thankfully, this major surgery – which required numerous, high-skilled surgeons – was a success.
Prior to her surgery, the plaintiff had to agree to medical lien agreements with her doctors, promising to pay the full amount of the fees billed. The providers later sold the bills and liens to MedFin, a medical finance company.
Later, the surgeon, citing patient privacy, refused to turn over his agreement with MedFin. The plaintiff still owed the full amount to MedFin, regardless of what MedFin paid the doctor. The court later ruled this wasn’t relevant anyway because it didn’t have any bearing on the reasonableness of the bill or the plaintiff’s responsibility to pay it.
The plaintiff sought to exclude any evidence at trial that her medical services were paid for, discounted to, or assigned to MedFin. The trial court granted this request.
At trial, the plaintiff asserted she had racked up nearly $200,000 in medical bills, and the doctors involved testified these were the amounts they billed, and these were ordinary, customary charges at reasonable rates.
The court granted a directed verdict favoring the plaintiff on the negligence issue, and jurors awarded the plaintiff $523,000 in personal injury damages, including $123,000 for past medical expenses and $45,000 for future medical expenses.
The defendant appealed only with regard to the prior medical expenses, arguing the reasonable value of the services was $71,000, while the jury awarded $52,000 more than that amount. The defendant argued that the amount the health care providers accepted for their services was all he should be compelled to pay for the plaintiff’s medical damages. The court called this notion “radical,” declining to adopt it.
Contact the Carolina injury lawyers at the Lee Law Offices by calling 800-887-1965.
Moore v. Mercer, Oct. 21, 2016, California Court of Appeal, Third Appellate District
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Haunted House Injury Lawsuit Settled for $125K, Oct. 26, 2016, Charlotte Injury Lawyer Blog