Accident Victim May Learn If Hospital Overcharged Her for Surgery

On June 15, the Georgia Supreme Court issued an important decision in a case that may affect the rights of uninsured individuals who attempt to contest large hospital bills. Victims of motor vehicle accidents often have to deal with the physical, mental and financial stress of recovering from their injuries. Unpaid medical bills often increase this stress, especially when hospitals file liens against a victim’s insurance benefits or any potential judgment against the persons responsible for the accident.

Bowden v. The Medical Center, Inc.

The victim in this case was a 21-year-old passenger travelling in a rental car one evening in 2011. The car was in an accident, and emergency medical personnel transported the victim to a Columbus hospital. She required surgery for a broken leg, a three-day hospital stay and additional outpatient physical therapy. The hospital ultimately billed the victim over $21,400 for medical services. She did not have any health insurance.

The rental car company offered the victim $25,000, the maximum value of its insurance policy on its rental vehicle. Meanwhile, the hospital filed a lien for its $21,400 bill. The three parties attempted to reach a settlement. The hospital said it would accept approximately $8,300 out of the $25,000 offered by the insurance company to release the lien, but the victim balked.

The hospital then filed what is known as an interpleader action in Georgia state court. Basically, an interpleader is someone who holds property on behalf of another but is unable to determine who to give it to. Here, the hospital paid the $25,000 to the court and asked it to litigate the dispute between the victim and the hospital over the lien.

In court, the victim moved to dismiss the lien, arguing the $21,400 bill was “grossly excessive and did not reflect the reasonable value of the care she received.” The hospital denied its charges were excessive and asked for a judgment to enforce the lien.

The case remains pending before the trial court. The Supreme Court was asked to settle a dispute arising from pre-trial discovery. The victim wants the hospital to produce information regarding its revenues and billing practices with respect to Medicare, Medicaid, and Georgia Blue Cross/Blue Shield, as well as the hospital’s own indigent care program. Essentially, the victim wants to compare what the hospital charges those payers against what it charged her. The hospital argued this information was irrelevant. The trial judge then ordered the hospital to comply. But last year, the Georgia Court of Appeals reversed the judge’s decision, agreeing with the hospital the victim’s information requests were too broad and irrelevant to her claim.

The Supreme Court, however, reversed the Court of Appeals, reinstating the trial judge’s original order compelling production. Justice David E. Nahmias, writing for the Supreme Court, said in the context of discovery, the victim’s requests were “relevant” as they could support her argument the hospital’s $21,400 bill was not reasonable. “The fair and reasonable value of goods and services is often determined by considering what similar buyers and sellers have paid for the same product in the same market,” Justice Nahmias observed. For example, if the requested information indicated insured and Medicaid patients only paid $1,000 for the same medical services the victim received, “a fairminded juror might conclude the reasonable charge for that care was much closer to $1,000 than to the $21,409.59” the hospital billed.

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