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

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

The justices unanimously found that the contracts affected person Lisa French signed earlier than a pair of again surgeries in 2014 at St. Anthony North Well being Campus don't obligate her to pay the hospital’s secretive “chargemaster” price charges, because the chargemaster — a listing of the hospital’s sticker prices for varied procedures — was never disclosed to French and he or she had no concept the chargemaster existed when she signed the contracts.

At the time, the hospital had represented to French that the surgical procedures were estimated to price her $1,337 out of pocket, along with her medical health insurance supplier overlaying the remainder of the invoice.

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

After her surgical procedures, the hospital billed $303,709 for French’s care; her insurance coverage 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 costs of the hospital” for her care, implicitly included the hospital’s then-secret pricing schema.

The state Supreme Courtroom justices rejected that argument, finding that “long-settled ideas of contract law” present that French didn't comply with pay the chargemaster prices when she signed the contracts, which never mention or reference the chargemaster.

“(French) assuredly couldn't assent to phrases about which she had no information and which were never disclosed to her,” Justice Richard Gabriel wrote in the courtroom’s opinion.

The justices also famous that chargemaster prices are divorced from actual costs for care. Few patients actually pay the chargemaster’s sticker prices for care, because insurance coverage firms negotiate lower prices with the hospital to develop into “in-network.”

“…Hospital chargemasters have develop into increasingly arbitrary and, over time, have misplaced any direct connection to hospitals’ actual prices, reflecting, as a substitute, inflated charges set to produce a focused amount of profit for the hospitals after factoring in reductions negotiated with non-public and governmental insurers,” Gabriel wrote.

Colorado lawmakers in 2017 handed a law 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 were in place when French underwent her surgical procedures in 2014.

Monday’s resolution overturns the Colorado Court of Appeals, which had found in favor of the hospital. The Court of Appeals’ ruling noted that hospitals can not at all times precisely predict what care a patient will need, and so they can’t lock in a firm worth, and concluded that the time period “all costs” in French’s contract was “sufficiently definite” as a result of the chargemaster rates were pre-set and fixed.

The state Supreme Courtroom justices as a substitute upheld the trial court docket’s ruling, wherein a choose found the contracts were ambiguous and sent the case to a jury to find out whether French breached her contract with the hospital and, if so, how a lot she should pay.

Jurors decided she did breach her contract but only owned the hospital an additional $767. The state Supreme Court docket’s ruling reinstates that verdict, said Ted Lavender, an legal professional for French.

“This needs to be the tip of the line for her,” he mentioned of French. “This opinion reinstates the jury verdict, which was a win for her, and (the case) will now revert back to that win. I have spoken with her at present and he or she could be very proud of the end result.”

A spokeswoman for Centura Health did not immediately comment Monday.