Medical Overbilling and Bad Faith

June 24, 2019 / Medical Malpractice

You go to the doctor, you whip out your insurance card, and you make the very reasonable assumption that your insurer will cover the majority of your treatment costs. Unfortunately, when hospitals and insurance companies are dishonest in their billing practices, patients can end up being stuck with exorbitant out-of-pocket expenses.

If you ever receive an outrageous medical bill, being familiar with medical bad faith claims and your legal rights will go a long way in helping you resolve the situation quickly and with minimum panic. You should also schedule a consultation with a health insurance bad faith attorney.

Overbilling and Balance Billing: A Serious Problem

All too often, patients are caught off guard by large medical bills as a result of two problems rampant in the American health care system: overbilling and balance billing. Balance billing occurs when a patient is taken to an out-of-network hospital (usually in an emergency situation), and the insurance company and hospital cannot agree on how much should be billed. The hospital demands the patient pay the difference, which can be thousands or tens of thousands of dollars.

Consider the example of Drew Calver, a school teacher who suffered a heart attack in 2017 and was rushed by a neighbor to the nearest emergency room. Calver later found out that the hospital was not part of his insurance network. Even after being reassured by hospital staff that his stay and treatment would be covered, he ended up receiving a bill for $161,941.

When Calver’s case was reviewed, it was found that a reasonable insurance reimbursement would have been closer to $27,000 — which was less than half of what Aetna ended up paying.

In many states, laws are in place to protect patients against these kinds of practices. But due to loopholes, self-insured employers are exempt from those state-mandated protections. This was the case with Drew Calver, whose employer was self-insured but hired Blue Cross Blue Shield to administer the plan.

When Bad Faith Turns Deadly

In 2014, an Oklahoma woman named Orrana Cunningham was diagnosed with stage 4 nasopharyngeal cancer near her brain stem. Her doctors told her that she needed a targeted form of radiation called proton beam therapy. Aetna denied the treatment numerous times, calling it investigational and experimental, even though her oncologists explained that it was necessary to kill the cancer while sparing her brain structure and function.

Eventually, Orrana and her husband mortgaged their home and set up a GoFundMe to pay for the therapy. By then it was too late. She died, in part from a viral infection to her brain. Last year, a jury awarded $25.5 million to Orrana’s family, determining that Aetna acted recklessly.

Unfortunately, hospitals and insurance companies don’t always have patients’ best interests in mind, resulting in financial ruin and even death. But you do have rights and legal recourse.

If you’ve lost a loved one to an insurance company’s bad faith medical decision, call the Indiana wrongful death lawyers at Stephenson Rife to schedule a consultation. We are compassionate and experienced attorneys who fight to win the maximum compensation for our clients.