Colorado Supreme Court docket rules in favor of woman who anticipated to pay $1,337 for surgical procedure but was charged $303,709

A girl who expected to pay $1,337 for surgery at a Westminster hospital nearly a decade ago but was billed $303,709 could lastly be off the hook for the massive bill after the Colorado Supreme Court docket ruled in her favor Monday.

The justices unanimously found that the contracts patient Lisa French signed before a pair of again surgeries in 2014 at St. Anthony North Health Campus do not obligate her to pay the hospital’s secretive “chargemaster” value rates, as a result of the chargemaster — a listing of the hospital’s sticker prices for numerous procedures — was never disclosed to French and she or he had no thought the chargemaster existed when she signed the contracts.

At the time, the hospital had represented to French that the surgeries were estimated to price her $1,337 out of pocket, together with her health insurance provider covering the remainder of the bill.

But the hospital’s estimate was based on French’s insurance supplier being “in-network” with the hospital, which it was not. A hospital worker gave a mistaken estimate after apparently misreading French’s insurance coverage card.

After her surgeries, the hospital billed $303,709 for French’s care; her insurance coverage paid about $74,000 and the remaining balance of $228,000 was disputed in a civil case.

Attorneys for Centura Well being, which operates the nonprofit hospital, had argued that the contracts, which required French to pay “all costs of the hospital” for her care, implicitly included the hospital’s then-secret pricing schema.

The state Supreme Court docket justices rejected that argument, discovering that “long-settled principles of contract law” present that French didn't agree to pay the chargemaster prices when she signed the contracts, which by no means mention or reference the chargemaster.

“(French) assuredly couldn't assent to phrases about which she had no information and which have been by no means disclosed to her,” Justice Richard Gabriel wrote within the court docket’s opinion.

The justices additionally noted that chargemaster prices are divorced from precise prices for care. Few sufferers actually pay the chargemaster’s sticker costs for care, as a result of insurance coverage companies negotiate decrease prices with the hospital to turn into “in-network.”

“…Hospital chargemasters have turn into more and more arbitrary and, over time, have lost any direct connection to hospitals’ actual prices, reflecting, as an alternative, inflated rates set to supply a focused amount of revenue for the hospitals after factoring in discounts negotiated with private and governmental insurers,” Gabriel wrote.

Colorado lawmakers in 2017 passed a regulation requiring hospitals to make some self-pay costs public, and in 2019, a federal agency required hospitals to make their chargemaster costs public. None of those protections have been in place when French underwent her surgical procedures in 2014.

Monday’s resolution overturns the Colorado Courtroom of Appeals, which had found in favor of the hospital. The Courtroom of Appeals’ ruling noted that hospitals cannot all the time accurately predict what care a affected person will want, and so they can’t lock in a firm value, and concluded that the term “all prices” in French’s contract was “sufficiently definite” because the chargemaster charges were pre-set and fixed.

The state Supreme Courtroom justices as a substitute upheld the trial court’s ruling, during which a judge found the contracts had been ambiguous and despatched the case to a jury to determine whether French breached her contract with the hospital and, in that case, how a lot she should pay.

Jurors determined she did breach her contract however solely owned the hospital an additional $767. The state Supreme Court docket’s ruling reinstates that verdict, said Ted Lavender, an legal professional for French.

“This must be the tip of the line for her,” he said of French. “This opinion reinstates the jury verdict, which was a win for her, and (the case) will now revert again to that win. I have spoken together with her right this moment and she or he is very pleased with the consequence.”

A spokeswoman for Centura Well being did not instantly remark Monday.