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Legal experts say contract law should already protect you from surprise medical bills

contract law

Joaquin Lopez received an $8,000 bill from a hospital, in addition to the $11,000 he and his insurance already paid. For patients like Lopez, a surprise medical bill like this leaves them powerless.  Now legal experts say contract law should already protect them.

Some legal scholars say patients already have protection against some of the highest surprise charges under long-standing conventions of contract law.

Contract law is based on a centuries-old concept of “mutual assent,” meaning both sides agree to a price before services are rendered, Barak Richman, a law professor at Duke University, told Kaiser Health News. This is why many states require written estimates before someone receives a service, such as from a mechanic or lawyer.

So how much should patients be expected to pay when little to no information about the cost of a procedure is provided beforehand? Contract law would require medical providers to charge only “average or market prices” without a clear upfront price, Richman said in the article.

Currently, when hospitals bill out-of-network care it’s at list prices, or their highest charges.

Courts have started to step in to decide cases when a patient receives a large surprise hospital bill from an out-of-network provider. Judges in New York and Colorado have ordered hospitals to accept amounts much closer to what they agree to receive from in-network private insurers or Medicare.

Joaquin Lopez has hired a lawyer to fight his $8,000 bill. He has written to the hospital that treated him, disputing that he owes more than was already paid.

Have you taken a surprise hospital bill to court? Share your story with Voices for Affordable Health.