Information on Ohio's Consumer Laws from Attorney Daniel Myers, Myers Law, LLC, not legal advice
Recently, Attorney Dan Myers of Myers Law teamed up with Scott Perlmuter of Tittle & Perlmuter to take on the unfair, deceptive, and unconscionable acts of hospitals and other medical providers in Ohio, starting with the unfair, deceptive, and confusing billing practices of the Cleveland Clinic. But this effort does not end with the Cleveland Clinic. Dan has already sued University Hospitals for similar unfair and deceptive billing / estimate conduct.
Since the beginning of 2020, Myers Law focused its efforts on fighting illegal and unfair billing and pricing practices of hospital systems across Ohio. From various patients treated in different hospital systems, Myers Law has discovered illegal price inflation, surprise bills, overbilling, and even patients being sent to collections when the hospital system actually owes the patient a refund! Unfortunately, none of this is isolated, and it has been going on for decades. Myers Law’s goal is to end illegal, unfair, and deceptive hospital billing practices for good in Ohio.
It is important to note that these cases are not about the doctors, nurses, or skilled health professionals that give life-saving care and world-class treatment to patients. The medical professionals at the Cleveland Clinic, University Hospitals, and other systems, do a fantastic job, and we join everyone else in praising them for their work, including how they have risked their health and their lived while handling the current COVID-19 crisis. But these lawsuits and billing disputes are not about them. These cases are about addressing the illegal and confusing acts that are the rule, not the exception, in hospital billing administration, something that so many of us have experienced, more than once, in our lives.
Hospitals have avoided providing patients estimates of the cost of their services, resulting in surprise bills and overbilling. Hospitals have refused to provide patients with the proper, legally required receipts for patient co-pays, deductibles, co-insurance, or other payments, effectively hiding the true cost of healthcare and true financial liability from patients. This conduct causes mass confusion over what is owed for medical services and procedures, it results in overbilling and double-billing, it allows hospitals to keep and not apply patient payments, it causes patients to suffer enormous stress, and it often ends up with patients suffering financially and being pursued by debt collectors.
Just like car mechanics, construction contractors, nursing homes, and other service businesses, hospitals are required to comply with Ohio consumer protection laws, including the Consumer Sales Practices Act. This law was passed in the 1970’s, and hospitals have been on notice for decades that the law applies to them–the big players in the medical industry, like the Cleveland Clinic, University Hospitals, Summa Health, Promedica, and others, know this. They know that they are not above the law because courts have already told them that they have to comply with the requirements of the Consumer Sales Practices Act.
Based on our review of different patient bills, personal experience, and publicly available pleadings, hospitals across Ohio routinely violate many consumer protections and rights. Most often, these include:
Hospitals often violate other patient rights, but the above are the most often ignored in billing and collection efforts.
The law requires contractors, car mechanics, and hospitals all to provide this information to consumers so that consumers are protected from higher-than-anticipated charges, surprise bills, unauthorized charges, overbilling, and “lost” payments. For whatever reason, hospitals appear to be under a false belief that they are above the law–that they are not required to provide this information or honor their patients’ right to this information because they are unique. There is nothing unique about their billing and collection process. While many hospitals are set up as charities, they bill like any other business. In the words of the Supreme Court of Ohio:
“It is also noted that the average nonprofit hospital of today is a large well run corporation, and, in many instances, the hospital is so ‘businesslike’ in its monetary requirements for entrance and in its collections of accounts that a shadow is thrown upon the word, ‘charity.'”
You wouldn’t hire a contractor to replace your roof if they told you “I have no idea what I’m going to charge you–just let me do the work and I’ll tell you what you owe me when it’s done.” You wouldn’t take your car to a mechanic that tells you “I can’t give you an estimate because the charges might be different later, so just leave your car here and you’ll just owe me whatever I say you owe me.” Not only is it unfair to force a consumer to accept those terms, it is illegal. It is illegal for the mechanic, just as it is illegal for the contractor and the hospital system, to refuse to give you an estimate when you ask for one. It is illegal for them to refuse to tell you that you have the right to get an estimate. It is illegal for them to charge you more than the estimate unless they get your prior approval for the increased costs. This is nothing new, and it isn’t overly confusing for hospitals. These regulations were created by the Ohio Attorney General, and they are easily found in the Ohio Administrative Code, in OAC 109:4-3-05. These rights are more important, not less important, in the context of medical services and hospital services. You can decide not to use a dishonest mechanic or secretive contractor. But you don’t always have that same choice with all health decisions, as you may believe you are financially forced to use a particular hospital depending on your insurer’s network of providers, or due to the high pressure tactics used by hospitals. Consumers need more information, not less, when making these hefty financial and medical decisions.
Patients need this information to protect themselves and to empower them with the information needed to make the financial and health decisions that they are expected to make. If a medical provider were upfront and honest about its services, patients could decide whether they want to approve the service, stay and have the procedure performed, or go elsewhere. For example, if a hospital charges $800 for a non-emergency ultrasound, but the patient also has the time to get that exact same ultrasound with the same equipment from a different provider for hundreds of dollars less, the patient should be given that information so the patient can made that decision. If the patient risks owing many thousands of dollars if insurance denies coverage, but can schedule it later to save money, or could save money by paying cash up front with a discount–that is something the patient would obviously like to know. Hiding this information increases the cost of healthcare for patients without improving the patients’ health.
Also, if the patient is on the fence about an elective procedure, it would help them know what they might have to plan and pay for if the procedure is denied coverage by the health insurer. Patients could then consciously save money and plan for expensive procedures instead of being forced into bankruptcy protection or collections.
Patients could also avoid overpayments and double billing if hospitals just provided the receipts required by law for the payments. Dan Myers himself was charged an excessive and illegal amount by University Hospitals over an urgent care / express case visit. University Hospitals attempted to collect more than legally allowed, sent the bill to collections, and had that debt collector pursue Dan over the double billing, until Dan discovered that University Hospitals had the payment, and then some, all along. Dan had been overbilled, double billed, and Dan overpaid. University Hospitals admitted that they had the money the entire time. After the debt collection, illegal billing, and multiple phone calls with University Hospitals, Dan finally received a refund. How crazy is that. Hospitals do not provide required receipts or estimates, they double bill patients, and then they throw their patients to the debt collectors when they actually owe the patient a refund!
The first thing we need to do is to challenge illegal hospital billing practices. Right now, Myers Law is pursuing a class action against the Cleveland Clinic over some of these practices. Myers Law would like to hold other hospitals accountable, as well. To do that, we need to hear stories from people willing to stand up to illegal hospital billing so that we can address it and end it in the State of Ohio.
If you would like to share your story with someone from Myers Law, and be contacted about your issues with illegal medical billing and pricing practices, please contact us.
Next, people need to carefully watch and analyze their bills, insurance Explanations of Benefit (EOBs), and payments. It shouldn’t have to be this way, but until hospitals comply with the law, patients should put in the extra hard work that medical providers should be doing. You should compare the bill or account statement that the hospital sent you with your past payments. Did you pay a co-pay or deductible or co-insurance or other payment that does not show up or is not reflected on the billing statement? Did the medical provider apply your co-pay to the right services? Do you feel like you already paid this bill? Does the amount seem off? Then compare the billing statements and payment history with your prior payments (you should keep track of them since hospitals do not give you proper receipts) and you should compare the bill to the EOB you received from your insurance company (if you have insurance). Does the billed amount and dates of services match up to the amounts and services on the EOBs you received? If not, something is wrong and you need to contact your insurance company and the medical provider.
Even if EOBs and bills match, and the amount you owe looks correct, then there could still be a problem with the way something was billed, coded, or determined by your insurer. Although the hospital or medical provider should be doing this for you, and while this can literally take hours of your life to handle and it does not ensure that the bill is correct, it gets you closer to the correct place.
Finally, start demanding price transparency from hospital administration. Demand that they give you a written estimate. Demand a receipt that shows what your payment applies to, what you previously paid toward the service, and the total that is owed (but don’t be mean to the receptionists or admins or health professionals–this is often a hospital system policy/ administration problem, not an individual employee problem). Demand to know why bills are higher than the written estimates. Fight for your rights. Be kind, but demand change.