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

A woman who expected to pay $1,337 for surgical procedure at a Westminster hospital nearly a decade ago but was billed $303,709 may finally 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 back surgical procedures in 2014 at St. Anthony North Health Campus don't obligate her to pay the hospital’s secretive “chargemaster” price rates, as a result of the chargemaster — a list of the hospital’s sticker costs for various procedures — was never disclosed to French and she had no thought the chargemaster existed when she signed the contracts.

On the time, the hospital had represented to French that the surgical procedures had been estimated to price her $1,337 out of pocket, along with her health insurance provider covering the remainder of the invoice.

However the hospital’s estimate was primarily based on French’s insurance coverage 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 surgical procedures, the hospital billed $303,709 for French’s care; her insurance coverage paid about $74,000 and the remaining stability 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 fees 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 rules of contract legislation” present that French did not conform to pay the chargemaster prices when she signed the contracts, which by no means point out or reference the chargemaster.

“(French) assuredly couldn't assent to terms about which she had no data and which have been by no means disclosed to her,” Justice Richard Gabriel wrote in the courtroom’s opinion.

The justices also famous that chargemaster costs are divorced from precise costs for care. Few patients actually pay the chargemaster’s sticker prices for care, as a result of insurance corporations negotiate lower costs with the hospital to turn into “in-network.”

“…Hospital chargemasters have turn into more and more arbitrary and, over time, have misplaced any direct connection to hospitals’ precise prices, reflecting, as a substitute, inflated charges set to produce a focused quantity of profit for the hospitals after factoring in reductions 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 company 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 Court docket of Appeals, which had present in favor of the hospital. The Courtroom of Appeals’ ruling famous that hospitals can not always precisely predict what care a affected person will want, and so they can’t lock in a firm value, and concluded that the time period “all charges” in French’s contract was “sufficiently particular” because the chargemaster rates have been pre-set and stuck.

The state Supreme Court docket justices as a substitute upheld the trial court docket’s ruling, in which a decide discovered the contracts had been ambiguous and despatched the case to a jury to find out whether French breached her contract with the hospital and, if that's the case, how a lot she should pay.

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

“This should be the end of the line for her,” he stated of French. “This opinion reinstates the jury verdict, which was a win for her, and (the case) will now revert back to that win. I have spoken together with her at the moment and he or she may be very proud of the end result.”

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