When Lisa Melody French needed back surgery after a car accident, she went to a hospital near her home outside Denver, which reviewed her insurance information and told her she would be personally responsible for paying about $1,337.
But after the surgery, the hospital claimed that it had “misread” her insurance card and that she was, in fact, an out-of-network patient, court papers said. As a result, Centura Health, which operated the hospital, billed her $229,112.13. When she didn’t pay, Centura sued her.
“I was scared about it,” said French, 60, a clerk at a trucking company, who eventually filed for bankruptcy. “I didn’t understand because I kind of relied on the hospital and my insurance company to work out what I needed to pay.”
This past week, after a yearslong legal battle, the Colorado Supreme Court ruled that French did not have to pay the nearly $230,000 for the spinal-fusion surgery she underwent at St. Anthony North Hospital in Westminster in 2014.
It said she would have to pay only $766.74, apparently reflecting the remainder of her balance, as previously determined by a jury.
“I was very happy,” French said Friday. “I was glad not just for me but for other people. I think most people don’t get, like I didn’t get, how insurance and hospitals work.”
Centura Health did not immediately respond to requests for comment.
The unanimous ruling capped what French described as a stressful ordeal that began when her doctor referred her to St. Anthony North, telling her she needed back surgery or she could be paralyzed in a fall.
“Personally, it was really hard because I had never had surgery before,” she said. “I was already scared about that.”
Before her surgery, French signed two service agreements promising to pay “all charges of the hospital.”
Centura asserted that, because French was an out-of-network patient, those service agreements required her to pay the full rates, listed in a giant health system database known as a chargemaster — a catalog of the cost of every procedure and medical supply Centura provided.
In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said.
But the court found that French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms.
This article originally appeared in The New York Times.
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