The California Supreme Court has been asked to look at an appellate court decision involving a Fresno hospital patient’s emergency department bill that could have a far-reaching effect on what hospitals in the state charge patients with no insurance.
At issue is an unpublished opinion by the 5th District Court of Appeal issued on July 11 that would allow self-pay patients who were treated at two Fresno-area hospitals to challenge their bills as part of a class action.
Community Medical Centers appealed the decision to the Supreme Court.
As it stands, the appellate court opinion could encompass thousands of self-pay patients who had hospital bills from Community Regional Medical Center in downtown Fresno and Clovis Community Medical Center. But its potential to become influential in lawsuits against hospitals statewide depends on the California Supreme Court.
Lawyers for the Fresno patient, Cesar Solorio, have filed a petition with the Supreme Court to get the appellate court opinion published, which would allow it to be case law. “Without the publication, the ruling would still apply to Fresno, the hospital here, but it wouldn’t be citable and usable for other cases in California,” said Barry Kramer, a Las Vegas lawyer who represents Solorio.
Community Medical Centers said the decision does not meet standards for publication and has filed a petition with the Supreme Court in agreement with the appellate court’s decision to not publish the opinion.
Glenn Melnick, an expert in health economics and a professor at the University of Southern California, said while the legal value of the case is still to be determined, the attention on hospital billing practices for self-pay patients is valuable. “Anything that helps to shine a light on this policy that needs to be changed would help all of us,” he said.
The Fresno case began after Solorio disputed a bill he received for treatment of an injured wrist at the emergency department at Community Regional Medical Center on Sept. 22, 2015. Kramer said a couple of X-rays were taken and Solorio had a splint put on his wrist. Solorio got a bill for $7,812.03.
Kramer sought certification of a class of self-pay patients, and a trial court denied the request. But the Fresno-based appeals court reversed the lower-court decision and certified a class of self-pay patients who were billed for emergency services at Community Regional Medical Center and Clovis Community Medical Center from Oct. 14, 2011, to the date of certification.
Kramer said Solorio signed an admissions contract agreeing to pay for the emergency room services he received in 2015 in “accordance with the regular rates and terms” of the hospital, but the contract did not specify prices. “The problem is that the patient is given no information whatsoever and no way of finding out what kind of rate schedule he’s going to be paying on,” Kramer said.
Patients with private insurance and those enrolled in government insurance programs, such as Medi-Cal and Medicare, pay negotiated rates. Patients without any insurance can end up paying “four to five times the cost of providing the services — or four to five times what others end up paying on the average,” Kramer said.
Community Medical Centers, which operates the regional medical center in downtown Fresno and the hospital in Clovis, disputes assertions that the process for billing self-pay patients is different from patients with insurance. When patients are discharged, the documents regarding their treatment are reviewed to determine what charges apply, said Michelle Von Tersch, vice president of communications and public affairs.
Community Regional sees more than 300 people a day in its emergency department, but self-pay patients are “only a very small percentage – between 1% and 2% – of the patients,” Von Tersch said in a written statement. Many who do not have health insurance qualify for financial aid programs, such as charity care, she said. “Furthermore, those who aren’t eligible for charity care – such as those with particularly high levels of income – can seek to negotiate payment plans or discounts on a case-by-case basis through our Business Office.”
Kramer said self-pay patients get large bills that they can’t pay. Some patients end up in collections and some end up in bankruptcy, he said. “It’s a very unfair process and the hospitals don’t even let these patients know in advance they’re going to end up with a bill for several thousand dollars for an issue that is very minor.”
Hospital pricing should be transparent, Kramer said. “I don’t care if they want to tell you, ‘We’re going to give you an aspirin and we’re going to charge you $50,000,’ if they’re not hiding what they’re doing.”