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Altering a consent form could protect you from surprise medical bills

If you or a loved one go to the emergency room for treatment, you probably have more on your mind than the language in the hospital’s financial and treatment consent form.

But when Stacey Richter’s husband went to a New Jersey emergency room for a possible heart attack, she was worried about a big bill from the hospital if the ER wasn’t in their health insurance network.

Instead of signing the consent form handed to her, Richter crossed out sections calling for her to pay whatever was charged by the hospital. Instead, she wrote in her own payment rate maximum of two times what the federal government would cover under Medicare. This is a rate some consider acceptable by most providers.

“And then I signed it, took a picture of it and handed it back to them,” Richter, co-president of the consultancy Aventria Health Group, told Kaiser Health News.

Altering consent forms in this way is a largely untested idea, but advocates say it could provide some protection from surprise bills. While consumers wait for lawmakers to tackle the issue, it also might be one of the few options available right now.

“And then I signed it, took a picture of it and handed it back to them,”

Admission and financial forms serve as contracts outlining the services a hospital will provide for payment. Putting a customer on the hook for “total charges,” as Rickter’s form outlined, means they could face enormous bills for facilities or providers that are out-of-network, even if the hospital is in-network.

Writing in your own payment limits might give you leverage in negotiations or even in courts if payment disputes arise. Advocates and some legal scholars say it at least is proof you didn’t agree to pay the total charges. However, there’s no guarantee the hospital will later agree to proposed limits.

The practice is relying on state contract law for protection, which requires mutual assent. Law professor Barak Richman told KHN that patients can seldom truly give their “mutual assent” because they are rarely told the true price of care before signing. Richman believes the process is deeply exploitive.

In Richter’s case, a surprise bill never arrived. She and her husband don’t know if it’s because their insurance covered everyone who saw him, or if it was her proactive stance on the forms.

“No one thinks we can solve this national epidemic of surprise bills with individual court cases,” Richman said in the article. “But this could create an awareness for what people are signing” when they receive care.