How Hospitals Sidestep Your Health Insurance and Force a Lien
Hello, I’m Bryan Comer from the law firm of Tobias, McCormick and Comer. In our last video we discussed the interrelationship between health insurance (private health insurance) and a hospital bill or doctor's bill that patients acquire after they've been hurt by somebody else, whether it be from an automobile wreck or they fall on somebody else's premises due to a defective or unreasonably dangerous condition or even from a defective product. And I want to talk a little bit more specifically about something that we've seen here at our firm at Tobias, McCormick and Comer and the steps that we've taken to combat it, to protect people both our clients and then people who aren't yet our clients. And you know we talk about us being real people helping real people and one of the things that I’m most proud of, what we've been able to accomplish here is the work that we've done to protect citizens of Alabama against some really unfair practices that were happening. We talked yesterday about how some health insurance companies or excuse me how some hospitals have employed third-party billing companies to try to sidestep private health insurance and I’m not going to go recap everything that we talked about yesterday, for more information on that and how that inner relationship works I encourage you to watch the video that we did just before this one.
But essentially the hospital is supposed to file the claim with private health insurance and then the private health insurance pays an amount to satisfy the bill, and that's typically a percentage of the bill. Some private health insurance companies have a percent that they'll pay and then once the injured person meets a co-payment or deductible then the hospital is supposed to extinguish the remaining balance of the bill. And so what companies like RevClaims were doing was if they found out while the patient was in the hospital that he or she had been hurt by someone else, again whether it's a wreck or a slip and fall or a defective product cause a serious injury, they would obtain information from the injured patient oftentimes in the waiting room of the hospital and try to obtain who the liability insurance companies the automobile insurance companies are, and they did it under the guise of ‘we want to make sure that the responsible party pays’. And that all sounds fine except what was really happening is RevClaims would use the information that people were giving them and then would go and file a lien in probate court in the county where the person resided so either here in Mobile County or in Baldwin County they would file a hospital lien and you can imagine that if someone's been seriously injured and has been in the hospital for one week two weeks three weeks then the bills could be astronomical and then the patient after being discharged from the hospital gets a notice of lean in the mail that could be six figures and that was obviously extremely alarming and what was especially terrible was that the lien would have never been in place had the insurance company, the private health insurance company been billed to begin with.
And so we actually had filed several lawsuits against RevClaims for this practice and as a direct result of that we learned how to make sure that the process is followed properly, but not only that, in addition to helping our current clients and future clients we may have we also were able to actually have the law changed to make sure that this practice goes away. And so what we did is we let legislators and local lobbying groups know of the practice and what was really happening and then that directly led to the law being changed and that law which is found in the Alabama code that is the actual set of books that contains the laws that are written by the legislature that the governor then signs into law the actual law was changed and this particular statute is section 35 11-371 subsection b and what it says is that no health care provider no hospital shall file a lien shall perfect a lien against a patient who has private health insurance unless the hospital first tries to or first files the claim with the patient's private health insurance and the health insurance company refuses to pay it. So in other words what has to happen is if you show up having been injured by someone else and you present a hospital with your insurance and the hospital accepts that insurance they must file the claim with that insurance company and accept as payment in full the amount of money that the insurance company pays them pursuant to any contracts that they have plus any kind of copayment or deductible so what that really means is you show up you've been injured you hand them your insurance card they bill your private health insurance company you make your co-payment payment to the hospital and then the claim is extinguished.
Well unfortunately what has happened is since this law has gone into effect companies like RevClaims have changed their practices somewhat or changed their approach but are still trying to accomplish the same result - they're still trying to get full payment for a hundred cents on the dollar, a hundred percent of the bill, as opposed to billing health insurance and receiving an amount less than that. One thing that's really troubling we've seen our clients receive copies of letters that are going to automobile insurance companies and other insurance companies that have a letter showing the full amount of the hospital bill that was incurred not the reduced amount that health insurance pays and asking the automobile insurance company to accept this letter and listed charges as a lien on any payment made on the claim. They're not filing it in probate court anymore but they're still asking the automobile insurance companies to accept it as a lien to treat it as a lien and oftentimes the automobile companies insurance companies do that.
And so that is why it is critically important to hire lawyers who know how to navigate this complicated arena we here at Tobias, McCormick and Comer we have 65 years of combined experience between the three of us representing people who've been hurt. Not only do we understand how to try the case, how to litigate the case, but also how to navigate pitfalls like this and we understand the processes that are in place and the forms to request and what has to happen to make sure that even if a letter like this goes out that the injured person our clients don't get stuck with the full bill at the end of the day because that ultimately reduces the amount of money that goes in their pocket once the case is concluded and so it is critically important when you're selecting a firm to understand: does this firm know how to handle this? This is something that we've worked on for a long time and we're more than happy to assist you with this so if you have any questions or if you or a loved one have been hurt by someone else pick up the phone and give us a call we offer a free consultation our number is 251-432-5001 or you can see us on the web at tmclawyers.com. We are real people who help real people. We are in the trenches every day fighting for clients and making sure that they don't get taken advantage of. Thank you.