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> Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.” > In Centura’s view, the service agreements “wer

by tromp 4y ago

> Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.” > In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said. > But the court found that Ms. French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms. > “Indeed, Centura representatives testified that the chargemaster was not provided to patients, and in this very litigation, Centura refused to produce its chargemaster to French, contending that it was proprietary and a trade secret,” Justice Richard L. Gabriel wrote. Beyond ludicrous...

pevey 4y ago
It’s amazing that any of these “agreements” are ever upheld by courts. As standard procedure, you have to agree to any and all charges, but in most cases they refuse to give any estimate of what those charges might be. They are “trade secrets.” But if you don’t agree, you cannot get lifesaving care. It is unconscionable. In this case, she is lucky they gave her that insurance estimate. Usually they refuse specifically for the reason of what happened in this case. They expect you to agree to pay whatever they decide later. And people keep trying to argue the US has a great healthcare system. It is beyond broken. The very rich don’t have to worry, the very poor don’t have to worry. The rest of us can get screwed if we have the very bad luck of being US citizens who happen to get sick or into an accident.
- user3939382 4y ago
  Totally agree. All these agreements are signed under duress and ask the signer to agree to pay an amount while making it impossible for the signer to know whether that’s possible.
  - babyshake 4y ago
    If you don't sign and you need treatment to live, aren't doctors obligated to treat you per the Hippocratic oath?
    - cool_dude85 4y ago
      Are you dying, like, right now? Or are you just going to die in a few months? Come back when you're dying.
- 88913527 4y ago
  You can always try a different hospital for better service. Of course this won't work in situations where timing is critical, but most surgery is scheduled. We might as well treat it for the business that it is. If they can't give you a reasonable estimate up front, then don't sign the paperwork. If they care about earning your money they will negotiate with you, and it's always better to negotiate terms up front proactively than deal with it reactively. The strongest power a consumer has is to vote with their money.
  - est31 4y ago
    > If they can't give you a reasonable estimate up front, then don't sign the paperwork. That's the issue, they don't give you estimates that they are actually bound by.
    - 88913527 4y ago
      And if you're an hour away from being in the operating theater, and they have all the specialists there, and in that moment you choose not to sign-- it's more their problem than yours.
      - FredPret 4y ago
        …no it isn’t? You need to get surgery, they want to provide surgery
        crooked-v 4y ago
        That's what makes it your problem. They can just say 'no' until you sign the document agreeing to pay whatever they bill you later.
        OJFord 4y ago
        I think GGP commentor typo'd - it says the opposite at time of writing.
      - 4y ago
- agiamas 4y ago
  agreed. You are under huge distress and don't have a viable alternative and your life is in danger and you sign what is really, a contract to pay with the amount to be paid being blank. So essentially and legally speaking, how is this different than blackmail?
  - SemanticStrengh 4y ago
    is there a limit? Can you legally enforce a hidden 1 billion dollar debt to someone?
    - drdec 4y ago
      It would be dischargeable in bankruptcy so there is a practical limit.
    - JJMcJ 4y ago
      Usually courts won't uphold "unconscionable" charges. Charge someone $1 billion to change a tire. Nope, nope, nope, as an example.
      - SemanticStrengh 4y ago
        but somehow 229K is Okay? Where is the limit
        JJMcJ 4y ago
        Hospitals seem to have the world hypnotized.
- prepend 4y ago
  > And people keep trying to argue the US has a great healthcare system. I’ve never heard anyone argue this. The common argument is that it really sucks and that proposed changes suck as well. So the argument isn’t “don’t change because it’s great.” The argument is “It’s terrible and I’m worried that if you change it, it will get worse.”
  - tomxor 4y ago
    I've come across a number of HN commenters claiming US healthcare is better than the EU or UK. I'd argue it's pretty broken compared to both. The UK's NHS is far from perfect yet serves the majority of people well without bankrupting them. Countries of the EU will have varying quality of healthcare, yet I'd still trust them over the US due to my fear of the US's highly profit driven system (which can cost you more than money). I suspect those claiming US healthcare is superior are able to pay quarter of a million without blinking - however they still run the risk of unnecessary surgery and aggressive prescription of addictive substances.
    - BobbyJo 4y ago
      I think we can separate the administration of the care from the are itself. I believe the US has among the best care. I also believe our administration of said care is among the worst, if not the worst.
      - tomxor 4y ago
        True, I wouldn't be surprised if the US was amongst the lead in quality of medical procedures - when that procedure is necessary... but beyond administration, there have been numerous instances of doctors being exposed for electing patients for unnecessary procedures driven by profits, and other procedures being recommended when scientific evidence suggest the procedure has no clear benefit - no matter the quality of surgery, it always comes at significant risk and cost to your body, it's not a magic wand; it's a traumatic intervention that requires your body to go through a lot of recovery with possible lasting effects. This can be true to a lesser extent for less severe medical interventions too. So my point is, what use is excellent "care" if not only it's life endingly expensive, but it's also prescribed immorally to the point of actually causing harm!
- chimeracoder 4y ago
  > And people keep trying to argue the US has a great healthcare system I've never heard anyone argue that the billing and payment aspects of the US healthcare system are great. I have heard people argue that the quality of care (by various metrics) or availability of services are great, but that's a different argument, and not mutually incompatible with having a broken payment and billing infrastructure. > The very rich don’t have to worry, the very poor don’t have to worry. I'm not sure how you're arriving at the conclusion that "the very poor don't have to worry"
bshep 4y ago
I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay. I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document? Edit: Or imagine a disgruntled employee in the copy room changing the form?
- Peku 4y ago
  There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...
- Vecr 4y ago
  It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.
  - bshep 4y ago
    In my experience these forms are only signed by patients, so why are they valid in those cases?
    - lisper 4y ago
      The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
      - DennisP 4y ago
Chris2048 4y ago
> contending that it was proprietary and a trade secret surely once a patient gets a bill (preferably itemized) the secret price of something is no longer secret. Further, what ensures there even is a consistent price if they refuse to disclose it?
deleted 4y ago
[deleted]

by tromp 4y ago

pevey 4y ago

It’s amazing that any of these “agreements” are ever upheld by courts. As standard procedure, you have to agree to any and all charges, but in most cases they refuse to give any estimate of what those charges might be. They are “trade secrets.” But if you don’t agree, you cannot get lifesaving care. It is unconscionable. In this case, she is lucky they gave her that insurance estimate. Usually they refuse specifically for the reason of what happened in this case. They expect you to agree to pay whatever they decide later. And people keep trying to argue the US has a great healthcare system. It is beyond broken. The very rich don’t have to worry, the very poor don’t have to worry. The rest of us can get screwed if we have the very bad luck of being US citizens who happen to get sick or into an accident.

user3939382 4y ago
Totally agree. All these agreements are signed under duress and ask the signer to agree to pay an amount while making it impossible for the signer to know whether that’s possible.
- babyshake 4y ago
  If you don't sign and you need treatment to live, aren't doctors obligated to treat you per the Hippocratic oath?
  - cool_dude85 4y ago
    Are you dying, like, right now? Or are you just going to die in a few months? Come back when you're dying.
88913527 4y ago
You can always try a different hospital for better service. Of course this won't work in situations where timing is critical, but most surgery is scheduled. We might as well treat it for the business that it is. If they can't give you a reasonable estimate up front, then don't sign the paperwork. If they care about earning your money they will negotiate with you, and it's always better to negotiate terms up front proactively than deal with it reactively. The strongest power a consumer has is to vote with their money.
- est31 4y ago
  > If they can't give you a reasonable estimate up front, then don't sign the paperwork. That's the issue, they don't give you estimates that they are actually bound by.
  - 88913527 4y ago
    And if you're an hour away from being in the operating theater, and they have all the specialists there, and in that moment you choose not to sign-- it's more their problem than yours.
    - FredPret 4y ago
      …no it isn’t? You need to get surgery, they want to provide surgery
      - crooked-v 4y ago
        That's what makes it your problem. They can just say 'no' until you sign the document agreeing to pay whatever they bill you later.
        OJFord 4y ago
        I think GGP commentor typo'd - it says the opposite at time of writing.
    - 4y ago
agiamas 4y ago
agreed. You are under huge distress and don't have a viable alternative and your life is in danger and you sign what is really, a contract to pay with the amount to be paid being blank. So essentially and legally speaking, how is this different than blackmail?
- SemanticStrengh 4y ago
  is there a limit? Can you legally enforce a hidden 1 billion dollar debt to someone?
  - drdec 4y ago
    It would be dischargeable in bankruptcy so there is a practical limit.
  - JJMcJ 4y ago
    Usually courts won't uphold "unconscionable" charges. Charge someone $1 billion to change a tire. Nope, nope, nope, as an example.
    - SemanticStrengh 4y ago
      but somehow 229K is Okay? Where is the limit
      - JJMcJ 4y ago
        Hospitals seem to have the world hypnotized.
prepend 4y ago
> And people keep trying to argue the US has a great healthcare system. I’ve never heard anyone argue this. The common argument is that it really sucks and that proposed changes suck as well. So the argument isn’t “don’t change because it’s great.” The argument is “It’s terrible and I’m worried that if you change it, it will get worse.”
- tomxor 4y ago
  I've come across a number of HN commenters claiming US healthcare is better than the EU or UK. I'd argue it's pretty broken compared to both. The UK's NHS is far from perfect yet serves the majority of people well without bankrupting them. Countries of the EU will have varying quality of healthcare, yet I'd still trust them over the US due to my fear of the US's highly profit driven system (which can cost you more than money). I suspect those claiming US healthcare is superior are able to pay quarter of a million without blinking - however they still run the risk of unnecessary surgery and aggressive prescription of addictive substances.
  - BobbyJo 4y ago
    I think we can separate the administration of the care from the are itself. I believe the US has among the best care. I also believe our administration of said care is among the worst, if not the worst.
    - tomxor 4y ago
      True, I wouldn't be surprised if the US was amongst the lead in quality of medical procedures - when that procedure is necessary... but beyond administration, there have been numerous instances of doctors being exposed for electing patients for unnecessary procedures driven by profits, and other procedures being recommended when scientific evidence suggest the procedure has no clear benefit - no matter the quality of surgery, it always comes at significant risk and cost to your body, it's not a magic wand; it's a traumatic intervention that requires your body to go through a lot of recovery with possible lasting effects. This can be true to a lesser extent for less severe medical interventions too. So my point is, what use is excellent "care" if not only it's life endingly expensive, but it's also prescribed immorally to the point of actually causing harm!
chimeracoder 4y ago
> And people keep trying to argue the US has a great healthcare system I've never heard anyone argue that the billing and payment aspects of the US healthcare system are great. I have heard people argue that the quality of care (by various metrics) or availability of services are great, but that's a different argument, and not mutually incompatible with having a broken payment and billing infrastructure. > The very rich don’t have to worry, the very poor don’t have to worry. I'm not sure how you're arriving at the conclusion that "the very poor don't have to worry"

bshep 4y ago

I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay. I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document? Edit: Or imagine a disgruntled employee in the copy room changing the form?

Peku 4y ago
There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...
Vecr 4y ago
It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.
- bshep 4y ago
  In my experience these forms are only signed by patients, so why are they valid in those cases?
  - lisper 4y ago
    The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
    - DennisP 4y ago

Chris2048 4y ago

> contending that it was proprietary and a trade secret surely once a patient gets a bill (preferably itemized) the secret price of something is no longer secret. Further, what ensures there even is a consistent price if they refuse to disclose it?

deleted 4y ago

[deleted]