How Accurate Are Your Healthcare Estimates?

Hopefully fairly accurate, or you may find yourself stuck without payment from a patient. 

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Recently, the Colorado Supreme Court found that a patient did not have to pay $230,000 because the price was not disclosed in the hospital service agreements that she signed. 

The patient had received an estimate that her portion of a spinal fusion surgery would be approximately $1,300 after insurance. 

However, she received a bill for $230,000 after the hospital later determined she was actually out-of-network. 

She didn’t pay and the hospital sued her for breach of contract. 

The court found that the price was left open in the agreements so a ‘reasonable value rule’ would apply. In total, the patient paid $1,766. 

There are many things that can be gleaned from this particular case. 

First and foremost, it is essential to check insurance properly. 

With Surprise Billing, it is also incredibly important that Good Faith Estimates provided by your practice are as accurate as possible. 

While state laws may differ, pursuant to federal law, it is important to make sure your final bill to a patient is within $400 of your estimate. Even then, make sure to have your unforeseen reasons for the overage documented. 

If you need help with your estimates, billing, or audits, contact Rickard & Associates today!

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