{"id":52482,"date":"2020-07-24T14:04:46","date_gmt":"2020-07-24T20:04:46","guid":{"rendered":"https:\/\/dh.durangoherald.com\/tj\/centura-health-faces-class-action-lawsuit-over-billing-practices\/"},"modified":"2020-07-24T20:04:46","modified_gmt":"2020-07-24T20:04:46","slug":"centura-health-faces-class-action-lawsuit-over-billing-practices","status":"publish","type":"post","link":"https:\/\/dh.durangoherald.com\/tj\/centura-health-faces-class-action-lawsuit-over-billing-practices\/","title":{"rendered":"Centura Health faces class-action lawsuit over billing practices"},"content":{"rendered":"\n

\"Mercy
Mercy Regional Medical Center is one of 17 hospitals owned by Centura Health, which is facing a class-action lawsuit claiming the corporation sends surprise medical bills and inflates drug prices.<\/span>Jerry McBride\/Durango Herald file<\/span><\/figcaption><\/figure>\n<\/p>

Franklin Walter went to Mercy Regional Medical Center for a routine knee replacement in April 2019. What he came away with two months later was a surprise bill totaling $1,216.73. Without an explanation or itemized statement, Walter found himself indebted to the hospital after believing his insurance would cover all the costs.<\/p>\n

Surprise or inflated medical bills have fueled the push to reform the health care system in the United States, particularly in rural areas where care options are limited. One method of pushback against unexpected medical bills is the court system, which is where Walter has turned to file a class-action lawsuit against Centura Health in the U.S. District Court for the District of Colorado, for what he claims are predatory billing practices for Centura\u2019s own financial gain.<\/p>\n

Walter, a resident of Flora Vista, New Mexico, is asking for $5 million, an amount based on the number of people lawyers estimate were affected by Centura\u2019s billing practice. The case seeks to include all patients from Feb. 7, 2017, onward who did not receive an estimate of the amount owed before or at the time non-emergency care was provided and charged after the care was provided.<\/p>\n

Centura Health declined to comment for this story, saying it does not comment on litigation before filing an official response. The corporation is expected to file a response in August.<\/p>\n

Beyond compensation for what Walter and his attorneys claim to be a breach of contract, he also is using the lawsuit to push Centura to change its billing and pricing practices.<\/p>\n

\u201cIf you schedule an appointment for any type of prescheduled surgery, the hospital should know the cost beforehand,\u201d said Tim Blood, one of the attorneys on the case. A managing partner for Blood, Hurst & O\u2019Reardon LLP in San Diego, Blood has specialized in class-action lawsuits for almost 30 years.<\/p>\n

\u201cLay people are often surprised how commodified these procedures are,\u201d Blood said. And while hospitals are run like a business, and should be recognized as such, Blood said they are businesses that provide lifesaving care.<\/p>\n

Patients have to pay for the services a hospital provides, but \u201cthey should know what they have to pay for that service,\u201d he said, especially for something \u201cfrightening and personal\u201d like surgery.<\/p>\n

Contract requirements<\/div>\n

Like most hospital patients receiving nonemergency care, Walter had to sign a \u201cConsent for Medical Treatment\u201d contract that requires him to agree to pay all known and unknown costs associated of the knee replacement in order to receive it.<\/p>\n

But the contract also requires Centura, the health corporation that owns 17 hospitals and more than 100 physician practices throughout Colorado and Kansas, including Mercy, to provide Walter with an estimate of what he would have to pay out of pocket for the procedure.<\/p>\n

The contract between Mercy and nonemergency patients says: \u201cI acknowledge that estimated responsibility is due at the time of service and that any remaining charges are due and payable upon receipt of the bill.\u201d<\/p>\n

It is meant to be a protective measure against unexpected bills and overbilling for patients like Walter.<\/p>\n

But Walter claims Centura never provided him with an estimate of out-of-pocket charges. At the time, he thought that meant he owed nothing out of pocket for the surgery.<\/p>\n

But in June 2019, Walter received a statement with charges from the knee surgery.<\/p>\n

High drug costs<\/div>\n

Lawyers for the class-action lawsuit see the lack of transparency as preying on a particularly vulnerable group of people, such as retirees who rely on Medicaid. They also argue it is a breach of Centura\u2019s contract to bill patients after nonemergency procedures without disclosing the known costs beforehand.<\/p>\n

\u201cPeople in that age range will probably have prescriptions they need to bring with them,\u201d said Jordon Harlan, a lawyer with Harlan Law and one of the attorneys for Walter\u2019s class-action lawsuit.<\/p>\n

\"Julie
Julie Lonborg with the Colorado Hospital Association said standard medication prices are high in hospitals because the cost accounts for strict checks and balances in place to make sure patients get the right medications and the correct dosages.<\/span>Adobe Stock image<\/span><\/figcaption><\/figure>\n<\/p>

Centura charges patients after nonemergency procedures for prescription and over-the-counter medications they take during their time in the hospital, including those unrelated to the procedure. But the costs for those prescriptions are \u201cwholly arbitrary and grossly inflated\u201d over the price a patient would pay at the pharmacy, Walter\u2019s lawyers wrote in the complaint.<\/p>\n

During Walter\u2019s stay at Mercy, he took 13 500-milligram Acetaminophen pills. The hospital later charged him $39 for the pills, but a 200-pill container costs about $5 at most pharmacies.<\/p>\n

\u201cThat is an upcharge of several thousand percent per pill,\u201d attorneys wrote in the lawsuit complaint.<\/p>\n

Julie Lonborg, senior vice president of the Colorado Hospital Association, said people can\u2019t bring their own prescriptions or medication into the hospital because it is a safety issue.<\/p>\n

\u201cWe need to know what it is, otherwise it could cause problems with other medications,\u201d Lonborg said.<\/p>\n

And pharmaceutical companies charge hospitals more for drugs than pharmacies themselves, Lonborg said. The safety checks that hospitals conduct for medication are also strenuous, and the cost of medication and prescription drugs in hospitals accounts for that, Lonborg said.<\/p>\n

Hospitals work hard to ensure all of their patients receive the correct medication in the correct doses at the correct time, Lonborg said. The wrong dose to the wrong patient could have a \u201csubstantial impact on their health,\u201d she said.<\/p>\n

Lawsuit pushes for more transparency<\/div>\n

The Centura contract says it has \u201cpredetermined the charges for certain procedures, supplies and treatments,\u201d and those charges are \u201clisted in the Centura Health Physician Group fee schedule.\u201d But Blood said a fee schedule is not accessible to the patient.<\/p>\n

And the \u201cPricing\u201d webpage on Centura\u2019s site does not actually provide pricing information or the \u201cfee schedule\u201d referenced in the contract, just links to other webpages, according to the class-action complaint.<\/p>\n

Webpages like \u201cHospital Prices\u201d and \u201cPhysician Prices\u201d give patients an option to look up costs, but Walter\u2019s routine knee surgery, called anthroplasty, is not among the listed procedures and costs, according to the complaint.<\/p>\n

Blood said that is confusing and frustrating for patients, and Walter hopes his lawsuit will bring about more transparency.<\/p>\n

But Lonborg of the Colorado Hospital Association said hospitals in Colorado have more transparency than what is required nationally. A Colorado law from 2017 requires hospitals to post the costs for the most-recent and frequent treatments.<\/p>\n

The best thing patients can do to obtain a cost estimate before a procedure is to call their insurance company.<\/p>\n

Colorado lawmakers were working on simplifying the health care billing and payment system for the state, but COVID-19 caused a delay in that process, Lonborg said.<\/p>\n

Joe Hanel, spokesman for the Colorado Health Institute, said it is unusual for patients to receive a bill beforehand because medical billing is more complex than that.<\/p>\n

\u201cA lot of it has to do with your insurer, as well,\u201d Hanel said.<\/p>\n

But Walter\u2019s case is \u201ctesting a legal theory that it should be simpler than it is,\u201d he said.<\/p>\n

Different insurers negotiate with hospitals on prices. Even though the procedure is the same, the cost is different depending on whether the patient has Cigna or Anthem Blue Cross Blue Shield.<\/p>\n

\u201cIt\u2019s not a pricing system that is intuitive to anybody,\u201d Hanel said, but Colorado is \u201con the forefront in trying to address this.\u201d<\/p>\n

David Silverstein, founder and chairman of the nonprofit Broken Healthcare, said courts generally have not found medical providers guilty in class-action lawsuits because each individual involved in the class action is too different.<\/p>\n

However, Silverstein said things are changing. The U.S. Supreme Court is watching these cases, he said.<\/p>\n

\u201cWe need change,\u201d Silverstein said.<\/p>\n

ehayes@durangoherald,com<\/em><\/p>\n

Centura lawsuit complaint (PDF)<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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