The Supreme Court of Virginia has agreed to review a case focusing on whether a hospital can bill a patient the full amount of its charges when the hospital is “out-of-network” for the patient.
A Henry County judge last year forced a hospital to accept 25 cents on the dollar for a patient’s emergency room care after hearing testimony that the hospital would normally accept 25 percent if a patient arranged for pre-payment.
The patient, a banker who suffered apparent heart symptoms, had signed a contract presented to him at the Martinsville hospital. Judge David V. Williams ruled the contract lacked mutual assent, comparing the situation to a “Your money or your life” proposition.
The hospital contends Williams erred in concluding the patient’s signature did not establish mutual assent. The patient did not qualify for the discounts offered to “prompt-pay patients,” the hospital also says in its assignments of error.
Williams’ decision is a rare judicial rejection of hospitals’ so-called “balance billing,” the practice of accepting payment from an insurance company and then billing the patient at full price for the unpaid balance. The situation arises when the patient’s insurer does not have a contract with the hospital for reduced rates.
Patients often do not know whether providers are in their network when they get care.
A Kaiser Family Foundation study found that charges from out-of-network providers were a common factor for insured, non-elderly adults struggling to pay medical bills.
The Supreme Court agreed to consider Williams’ ruling on Nov. 1.