Posted Mar 2023
The inflated amounts detailed on healthcare provider bills and liens continue to be a recurring problem. These inflated charges have little basis in reality. Here is some additional information and resources since I last discussed this.
First, this past year the Arizona Legislature amended the health care lien statutes. A.R.S. § 33-931. The amended statute applies to health care provider liens that are filed for services beginning January 1, 2023. The statute exempts from a health care provider lien one-third of any third-party judgment, settlement, or award. The statute also requires a specific provision in the health insurance contract allowing a provider to assert a lien or assignment, otherwise, the provider may not do so. And, the statute requires the health care provider to compromise liens to what is “fair and equitable.” There are specific guidelines in the statute.
Second, plaintiffs continue to claim and disclose the phantom bills. Several law firms are redacting the amounts actually paid without stating such. In our initial discovery requests, we request unredacted records.
Third, in evaluating or negotiating the claim, in my opinion, the “reasonable amount” of the medical bill is approximately the amount paid plus an additional 20 – 30%. But, you will need to have a medical bill reviewer evaluate. I include a number of potential experts in the list below. Plaintiffs are using a separate IME doctor to review medical records and opine both on causation and to opine the amount billed was “reasonable.” They do this so they do not have to bring treating physicians to trial. We can challenge opinions on the “reasonableness” of the medical bills in the same way a plaintiff will challenge the medical bill reviewer.
Fourth, the Arizona Supreme Court determined there is no recapture lien or balance billing in Medicare cases. Ansley v. Banner Health Network, 248 Ariz. 143 (2020). This takes away the argument that the plaintiff is legally responsible for the difference between the amounts billed and the amounts paid. In Medicare cases, the only required reimbursement is the amount paid by Medicare. Health care providers may not circumvent this by imposing a lien. . .
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