Colorado Supreme Court docket rules in favor of woman who anticipated to pay $1,337 for surgery but was charged $303,709

A lady who expected to pay $1,337 for surgical procedure at a Westminster hospital almost a decade ago but was billed $303,709 might finally be off the hook for the large invoice after the Colorado Supreme Courtroom ruled in her favor Monday.

The justices unanimously found that the contracts affected person Lisa French signed before a pair of back surgeries in 2014 at St. Anthony North Health Campus do not obligate her to pay the hospital’s secretive “chargemaster” price charges, because the chargemaster — a listing of the hospital’s sticker prices for numerous procedures — was never disclosed to French and he or she had no idea the chargemaster existed when she signed the contracts.

At the time, the hospital had represented to French that the surgeries were estimated to price her $1,337 out of pocket, with her health insurance provider protecting the remainder of the bill.

But the hospital’s estimate was based on French’s insurance coverage provider being “in-network” with the hospital, which it was not. A hospital employee gave a mistaken estimate after apparently misreading French’s insurance coverage card.

After her surgeries, the hospital billed $303,709 for French’s care; her insurance paid about $74,000 and the remaining stability of $228,000 was disputed in a civil case.

Attorneys for Centura Well being, which operates the nonprofit hospital, had argued that the contracts, which required French to pay “all expenses of the hospital” for her care, implicitly included the hospital’s then-secret pricing schema.

The state Supreme Court justices rejected that argument, finding that “long-settled ideas of contract legislation” present that French did not conform to pay the chargemaster costs when she signed the contracts, which never mention or reference the chargemaster.

“(French) assuredly couldn't assent to phrases about which she had no knowledge and which had been by no means disclosed to her,” Justice Richard Gabriel wrote in the court docket’s opinion.

The justices additionally famous that chargemaster prices are divorced from precise costs for care. Few patients actually pay the chargemaster’s sticker prices for care, as a result of insurance coverage corporations negotiate decrease prices with the hospital to turn into “in-network.”

“…Hospital chargemasters have change into increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual costs, reflecting, as an alternative, inflated charges set to supply a focused quantity of profit for the hospitals after factoring in reductions negotiated with private and governmental insurers,” Gabriel wrote.

Colorado lawmakers in 2017 handed a legislation requiring hospitals to make some self-pay prices public, and in 2019, a federal agency required hospitals to make their chargemaster prices public. None of these protections had been in place when French underwent her surgeries in 2014.

Monday’s choice overturns the Colorado Courtroom of Appeals, which had present in favor of the hospital. The Court of Appeals’ ruling famous that hospitals cannot at all times precisely predict what care a patient will want, and so they can’t lock in a firm worth, and concluded that the term “all charges” in French’s contract was “sufficiently particular” as a result of the chargemaster rates had been pre-set and glued.

The state Supreme Court justices as a substitute upheld the trial court docket’s ruling, in which a judge found the contracts were ambiguous and despatched the case to a jury to find out whether or not French breached her contract with the hospital and, if so, how much she should pay.

Jurors decided she did breach her contract however only owned the hospital an extra $767. The state Supreme Court docket’s ruling reinstates that verdict, mentioned Ted Lavender, an lawyer for French.

“This needs to be the tip of the road for her,” he said of French. “This opinion reinstates the jury verdict, which was a win for her, and (the case) will now revert again to that win. I've spoken together with her at present and she could be very happy with the outcome.”

A spokeswoman for Centura Health did not immediately comment Monday.