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Surprise Bill Update: We're Winning!

Updated: Nov 16, 2021

Reminder: today's 1 PM EDT webinar is very timely: Overcoming Vaccine Hesitancy. It features the CDC's Dr. Christa-Marie Singleton along with uberguru Dr. Scott Conard. Register here to attend or get the recording.

 


We promised real-time updates on James Hamilton, who got hit with a $12,900 bill for an in-network ER visit (+$1750 in physician fees) that Medicare would have allowed less than $350 for. His insurance initially paid a little more than $2000.


By way of background, he had downloaded and copied down the Quizzify consent for 2x Medicare and gave it to them, and they treated him. The hospital had every right to decline his consent and treat him without agreeing to his financial consent. They didn't. They typed it in. The typed copy is nowhere to be found. But they sent the handwritten copy back to him:

Then, following the webinar and on the advice of the experts Marty Makary, Leah Binder, Marshall Allen (and of course Quizzify's Al Lewis), he wrote them a check for the amount of the consent.


We all agreed they'd be nuts to cash it and lose whatever shred of a case they had, but as you can see, they did. On the back of the check, James wrote FULL AND FINAL PAYMENT in BOLDFACED CAPS. If a creditor cashes that as is, it may or may not create a contract.


In this case, though, it likely does. There is offer-and-acceptance twice. (Or I should say, TWICE.) The contract was virtually certainly created at the time of service. If not, it was created when a bill was sent and paid, and the check was cashed for the agreed-upon amount, endorsed under the caption.

 

But wait...there's more. Now how much will the hospital pay?


You may recall from the webinar that insurance paid a bit more than $2000 of the $12,900. So now Mr. Hamilton has overpaid by that amount...and could try to get the money back from the hospital. (It is unclear whether the hospital would have to just reimburse the insurer rather than Mr. Hamilton, due to coordination-of-benefits limitations. That's above our pay grade.)


You may also recall from the webinar a nasty note from the hospital. Turns out two can play at the nasty note game. Here is the gist of the letter from Mr. Hamilton to the hospital. Note the olive branch at the end.


Dear ____,

If you look back at your notes, you'll see you agreed to a binding contract to treat me for 2x Medicare. To the extent you did not accept the contract by treating me without objection to my limited consent to pay, you did accept it by cashing my check duly marked "Payment in Full" for that exact amount.

We are happy to let the whole thing go now. We would like from you a complete discharge of all claims within the next 48 hours, to settle everything. In exchange, we will discharge you from all claims against you and sign a non-disclosure agreement allowing us to talk about this episode but without mentioning your name.


You picked the wrong person to overcharge this time. See this recorded webinar in which I described my experience. Note that we have four of the best-known people in healthcare surprise billing on this panel. Feel free to google on any of them and "surprise bills." I'll save you the trouble with Al Lewis, Here is his glowing writeup in the New York Times describing how to handle this exact situation. I handled it exactly the way he advised

Note that in the webinar, we did not use your name, mostly because we hope you will act rationally and realize that there is no upside in allowing us to let it be known in Hollywood that you did this...and got caught.


If we do NOT hear from you in 48 hours, here is what is going to happen:

  1. You will be sued for $2000, the amount you've collected from my insurance company in addition to the complete payment in full I sent you. You've now been overpaid by more than $2000.

  2. Should this proceed to collection, I have a copy of my current credit report. A diminution in my credit will result in additional damages, which I intend to collect. This will probably be a 5-figure sum, plus an apology. Plus I will not sign a non-disclosure agreement.

  3. Everyone in [this city] will be given access to this webinar, including your name.

And keep in mind that if we do go to court, and the judge finds that a contract was created (as is 100% likely), it is a matter of public record that you are willing to accept 2x Medicare for EMTALA services. It will make it that much harder for you to overcharge other people who use the same language we did, and we will make sure the entire city finds out about this.


PS To show that there are no hard feelings, once we settle this, I would be pleased to post a review wherever you like not mentioning this, but rather reporting that the actual care you provided was excellent. You solved my problem, and thank you for that.