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INsight | Federal Regulations for Hospital Online Billing

April 5, 2019

Attorney Dave Farnbauch sits down with INsight at the Sweeney Studios to talk about new federal regulations that make hospitals put their billing rates online.


Host: Welcome back. We’re here at the Sweeney Studios with Attorney Dave Farnbauch. We’re going to talk about new federal regulations that make hospitals put their billing rates online.

Dave: Right.

Host: That seems like a big deal to me.

Dave: Well, for many years, Charity, hospital billing rates, and we’re talking about a large list. I’ve seen some estimates, it could be 40 different thousand, 40,000 different items –

Host: Uh-huh.

Dave: -- that a hospital can charge for. They’ve claimed that this information about their billing rates is proprietary information or it’s a trade secret, so hospitals have been very reticent about, sort of, allowing access or disclosure of their billing rates.

Host: So this federal regulation now makes them put these rates online.

Dave: Right.

Host: Why?

Dave: Well, it’s for transparency. I think it’s going to be an effort, part of the effort to sort of drive the cost of healthcare down. In the United States, Charity, 17 percent of our gross national product is spent on health care, and the average family spends more than $9,000 a year for health care. And compared to other countries around the world, we, we spend a lot more of our, you know, disposable income on healthcare, so the politicians are trying to take measures to, you know, drive down the cost of healthcare, and one of the ideas behind this idea is giving consumers data, you know, for comparison about what different hospitals charge for different procedures and things that they do, and so consumers now have access to go online and do that research and compare apples to apples.

Host: So will this drive prices down? Will this, I guess I’m thinking, when I get a bill from the insur-, or not even a bill, but when I get a statement from the insurance and it says, “Here’s what the cost was. Here’s what our discount was. Here’s what you owe.” Because we all know our insurance deductible now is, for most of us, is so high that --

Dave: Right.

Host: -- most of the time we don’t meet it.

Dave: The way this new law, I think, is going to impact, you know, particularly what we’re interested in, as lawyers, is hospitals tend to, with, you know, sort of having no transparency –

Host: Uh-huh.

Dave: -- about their rates, they tend to target people that don’t, are not covered by a health insurance plan. So there are some people that are uninsured that, obviously, are going to want to know, be able to –

Host: The cash rates --

Dave: -- compare rates. And there’s also people that end up at a hospital that’s out of network –

Host: Uh-huh.

Dave: So they get charged with, what we call charge master rates. Those are sort of the, you know, the sticker price that the hospitals charge. They call those their charge master rates. And what we encounter in our practice is when clients of ours are injured in a motor vehicle accident, they’re frequently, will go to a hospital for treatment and these hospitals will file hospital liens where they try to recover their charge master rates, in other words, the sticker price --

Host: Uh-huh.

Dave: -- of those charges, from the proceeds of a personal injury case. So what we’ve been trying to do lately, when hospitals file these hospital liens, is to get information about their billing rates, so that we can prove to a judge when we’re resisting paying these sticker price rates for hospital charges, we’ll now be able to show them on their own, you know, website or whatever, what the hospitals are charging for their services and these charge master rates are just ridiculous. So it’s a way that we can get ammunition or information that the hospital puts out to take to court to show to a judge and say, “Look, Judge, these hospital rates that they’re charging, as part of their hospital lien, are just very unreasonable.”

Host: So the rates that they’re going to have to put online are not the charge master rates, they’re the actual rates that, let’s say, the insurance company puts on the --

Dave: Right.

Host: -- bottom line --

Dave: No, they, no, they are their charge master rates.

Host: Okay.

Dave: Okay. So most, most people are covered by a health insurance plan, so the different health insurance plan negotiate a much lower –

Host: Lower rate.

Dave: -- much lower rate.

Host: Okay. Dave: As does Medicare and Medicaid. They negotiate significantly reduced rates. So most people are not going to be sort of impacted by the charge master rates. But if you’re injured in a motor vehicle accident --

Host: That’s where it’s really going to count.

Dave: -- and they file a hospital lien, you’re going to want to have access to those charge master rates, so that you can prove that those rates are unreasonable.

Host: And it really is so, it gets so confusing, which is why, that’s where you come in. You know, my running joke is, “I’m not a doctor, I don’t play one on TV.” Turns out I’m not an attorney, either. And I don’t play one of those on TV, either. And so that’s where having experts like you guys at the Sweeney Law Firm is so very important because it can get really contentious because the hospital, they want their money and people don’t want to pay. It just gets contentious, and so why not let the experts be fighting for you. So if you’ve been in an accident, all you have to do is call the Sweeney Law Firm and let them help you out. They’ll be glad to look at your case and tell you if, if you need to move forward with that. Give them a call today or visit their website, sweeneylawfirm.com. We’ll be right back.

Read the full transcript here.