How to Handle Emergency Room Overcharges

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 What Are Medical Bills?

Medical bills are those expenses or costs that are related to various types of medical care, both for preventative care as well as treatment. These bills may cover anything from a routine checkup to a serious emergency treatment measure.

Medical bills are typically issued to individuals who visit hospitals or medical clinics. Health insurance can also play a major role in the payment of medical costs.

In the majority of cases, payments are made for medical expenses in increments not in the full amount. This applies especially to larger expenses.

Medical bills are legal obligations for patients who are required to pay back the debts that they owe for their care or treatment. Typically, medical bills cover costs including:

  • Hospital stays, including overnight and long-term stays;
  • Emergency room visits;
  • Costs that were related to ambulance services or other transportation services;
  • Various medications and prescriptions;
  • Care and treatment that was related to pregnancy or childbirth;
  • Surgery expenses;
  • Costs associated with therapy or rehabilitation procedures;
  • Medical consultation and advice fees;
  • X-rays and other specific procedures; and
  • Various other medical costs.

In addition to itemizing the different expenses that are associated with medical treatment, medical bills may also contain other important instructions and information, including:

  • Method of payment;
  • Payment frequency;
  • Interactions with medical or health insurance companies;
  • Consequences of non-payment or late payments; and
  • Various other provisions.

What Is an Emergency Room Overcharge?

If an individual has been treated in an emergency room at a hospital and they did not have health insurance, they may have been subjected to emergency room overcharges. Emergency room bills for patients who are not insured and do not qualify for Medicare, Medicaid, Medi-Cal, or any other type of coverage that is funded by the state, are typically much greater than the bills that are given to the insurance company for insured patients.

A hospital is required to charge an individual without insurance the same rate as an individual with insurance. Hospitals, however, often ignore this provision and engage in medical overbilling by overcharging a patient excessively for ER procedures that were not consented to or provided at any time during the ER visit.

Do I Have to Pay the Hospital Bill if the Emergency Room Visit was Overcharged?

Under the law, patients are obligated to pay the rate of emergency room charges for services if the patient consented to receiving the services in the emergency room and the patient actually received the services. Patients, however, are not legally obligated to pay for emergency room services that they did not consent to or actually receive.

If the patient was overcharged during their emergency room visit, they may be able to dispute those charges. In some cases, hospitals overcharging may simply be a clerical error that is easily resolved.

How Do I Know if I Have Been Overcharged?

An individual will know if they have been overcharged on the emergency room bill if that bill is 2 to 4 times the rate that is charged to insured patients who received the same treatment. In order for an individual to make this comparison, they will have to determine the rate for insured patients as well as determine the amount by which that rate differs from the rate they are charged.

For more information about issues related to emergency room charges, see the following LegalMatch articles:

Do Medical Bills Expire?

One common question from many patients is how long they have to pay their medical bills. The payment period for medical bills typically varies by health organization.

In many cases, an individual will have about 180 days to pay their medical bills before they are sent to collections. Collections is when the healthcare organization or hospital begins to make efforts to collect on the unpaid medical debt.

Once this occurs, that unpaid debt may be reflected on the individual’s credit score and may have negative effects on their credit. Unpaid medical bill debt can remain on an individual’s credit score for many years.

If the individual still does not pay after a bill has gone to collections, a medical organization may initiate a medical bill lawsuit against the debtor. It is important to be aware that there is a statute of limitations for things like medical debts.

These limitations will depend on the state in which the individual incurred the debt. Once the statute of limitation has expired, or passed, and no legal action is taken against the individual, they cannot be sued or forced to pay that debt that was owed.

In many cases, once the debt is passed, it will be bought by another creditor that will aggressively pursue action to make the individual pay the debt. However, once the limitations have run, they are no longer allowed to force the individual to pay.

Instead, they can only request that the individual voluntarily pay the debt. It is important to remember that the debt itself will never go away but the legal obligation to pay the debt can.

Can I Sue a Hospital for Emergency Room Overcharges?

Yes, an individual can sue a hospital for any excessive emergency room charges that they did not consent to or receive.

There are many attorneys who have filed lawsuits against hospitals claiming that patients have been overcharged for an emergency room visit since the patient is not obligated to pay for services that the patient did not consent to.

How Can I Prevent Emergency Room Overcharges?

There are several steps an individual can take to prevent and handle emergency room overcharges, including:

  • Requesting an itemized statement of the charges to see if what the individual was actually treated for;
  • Having their doctor review the statements;
  • Asking the hospital to audit the statements;
  • Asking the billing department for adjustments for anything that the individual did not approve or do; and
  • Having a patient advocate negotiate with the hospital to reduce the payment and amount owed.

Can I File a Lawsuit for Emergency Room Overcharges?

Yes, an individual may file a hospital overcharge lawsuit. Between the years 2006 to 2008, there were approximately 1 million patients who received refunds or adjustments to their hospital bill as part of class action settlements.

Hospitals refunded nearly 1 billion dollars to patients who were overcharged, mostly for emergency room care. If an individual believes they have been overcharged, they should consult with an attorney to determine if they can file a claim or join a class action lawsuit.

Do I Need an Attorney?

Medical bills can add up quickly and be very overwhelming to sort through. There are many opportunities for error in these types of bills, especially if you receive bills from multiple departments of the same hospital.

If you believe you have suffered an emergency room overcharge, it is important to consult with an insurance lawyer. Your lawyer can help you gather all of the bills and review them to determine whether you were overcharged.

If you were overcharged, your lawyer can help you dispute those charges and reduce your bill. If necessary, your lawyer will also be able to file a claim against the hospital if it will not remove any of the charges for things that were not done or that you did not consent to.

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