When Nicholas Dorado was injured in an auto accident, he discovered that the facility that treated him did not immediately submit the bills to his insurance company but looked for higher payments than those the insurance company was willing to make. This class action sues St. Vincent Community Health Services, Inc., St. Vincent Infirmary Medical Center, Catholic Health Initiatives Physician Services, LLC, and their insurer First Initiatives Insurance, Ltd. for changing their billing practices in cases such as auto accidents.
Plaintiff Dorado had his accident in July 2017. His treatment at one of the St. Vincent entities resulted in medical bills of more than $236,000. That amount was more than the limits of liability coverage of the driver who caused the accident. Dorado was covered by Health Advantage insurance, which could pay for his treatments.
But bills submitted to the insurance company would be paid at the agreed-upon, discounted rates in its contract with the medical facility. The complaint alleges that the St. Vincent entities did not want these discounted amounts.
In cases such as accidents, where patients “may have civil causes of action against third parties[,]”the complaint says, the St. Vincent entities may not timely submit the bills to the insurance company. They also do not give the patient proper itemized billing statements that contain things like diagnostic codes, CPT/HCPCS codes, or units of care that would enable the patients to submit their claims to their health insurance company themselves.
Instead, the complaint says, the St. Vincent entities seek higher payment in other ways, including “demanding cash payment directly from the patients, wrongfully placing liens upon patients’ third-party tort claims, seeking medical payment (med-pay or PIP) benefits from the patients’ auto insurers, turning said patients over to collection agencies, and/or reporting said patients to credit bureaus…”
In Dorado’s case, the St. Vincent entities filed a lien for nearly $219,000. Only after that did they submit his medical bills to his insurance company. The insurance company paid the bills.
In early 2018, Dorado was offered a settlement of $50,000, the amount of the other driver’s applicable coverage. He accepted it. However, the lien still existed. This delayed the settlement for the accident.
In the end, he had to pay $1,777.10 to satisfy the lien and have it released.
The class for this action is all persons who, during the statutory period, received health care from any entity owned, controlled, or managed by St. Vincent in Arkansas, where (1) the treatment was covered by valid, in-network, commercial health coverage, (2) the billing for the treatment was not timely submitted to the commercial insurance carrier, and (3) the St. Vincent entity or entities tried to get payment for the treatment through medical or hospital liens, submitting claims for medical treatment, or seeking payments directly from patients or their assets, such as tort recoveries.