Colorado Supreme Court to examine hospital billing in Centura Health case

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The Colorado Supreme Court will this week consider hospital billing practices after a woman who expected to pay $1,337 for surgery at St. Anthony North Health Campus was billed $303,709.

The case pits attorneys for patient Lisa French against Centura Health, which operates the nonprofit hospital in Westminster. The dispute centers on a contract French signed in which she agreed to pay “all charges of the hospital” for her care.

When she signed the contract ahead of a pair of back surgeries in 2014, the hospital had represented to French that the surgeries were estimated to cost her $1,337 out of pocket, with her health insurance provider covering the rest of the bill.

But the hospital’s estimate was based on French’s insurance provider being “in-network” with the hospital, which it was not. She also experienced what the hospital called “complications” after her second surgery — her attorneys say it was an extra morning in the hospital due to a slower than expected recovery — which together upped the bill to 227 times the hospital’s initial estimate.

The hospital relied on its then-secret “chargemaster” database to come to that higher price. The chargemaster, which was not referenced or disclosed in the contract French signed with the hospital, is a comprehensive list of prices the hospital charges — though, in reality, few patients pay the sticker price for care. Insurance companies can negotiate lower prices with the hospital and become “in-network.”

French’s insurance had no such agreement with the hospital, though French believed her insurance was in-network because a hospital representative told her it was after apparently misreading French’s insurance card, her attorneys said in court filings. The hospital’s attorneys said in a rebuttal filing that it is patients’ responsibility to understand their insurance coverage.

Colorado lawmakers in 2017 passed a law requiring hospitals to make some self-pay prices public, and in 2019, a federal agency required hospitals to make their chargemaster prices public. None of those protections were in place when French underwent her surgeries in 2014.

Of the $303,709 bill, French paid $1,000; her insurance paid about $74,000, and the remaining balance of $228,000 was disputed.

Judges on the civil case initially found that the hospital’s contract was ambiguous — in large part because it did not disclose the reliance on the chargemaster — and sent the case to a jury to determine whether French breached her contract with the hospital and how much she should pay; jurors decided she did breach the contract but only owed the hospital an additional $767.

Centura appealed and the Colorado Court of Appeals ruled in favor of the hospital, finding that its contract was not ambiguous and a jury shouldn’t have been allowed to determine how much money French owed the hospital.

The Colorado Supreme Court will hear oral argument on that issue — whether the hospital’s pricing and contract were ambiguous — on Tuesday.



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