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Are Hospitals Exploiting The No-Fault Insurance System?

On Behalf of | Mar 15, 2016 | No-Fault Insurance

Hospital Conglomerate HCA Hospital is asking a South Florida Court to dismiss a case arguing it has no merit and reject a bid to make it a class action. The suit has been brought by four Florida drivers, Marisela Herrera, Luz Sanchez, Nicholas Acosta and Wollmen who were involved in separate car accidents, treated at these hospitals and in each visit- the hospital took the entire $10,000.00 PIP benefits, and then some. It names as defendants JFK Medical Center, Memorial Hospital Jacksonville, North Florida Regional Medical Center and HCA Holdings Inc. This lawsuit claims hospitals are the ones ripping off consumers and exploiting the No-Fault system. According to the claimants’ attorney, the hospitals are purposely overcharging and thus taking the money from those needing the medical care and help. As expected, the Hospital attorneys refute the allegations and say if drivers have a problem, they should take it up with their insurance company that agreed to pay the charges.

In a court filing (what I expect is a Motion to Dismiss), Defense attorneys write “Plaintiffs apparently believe their insurers should have negotiated a better deal that would have covered more of Plaintiffs’ medical expenses and lowered their out of pocket costs. However, Florida’s PIP statute does not authorize a private right of action to challenge the amounts charged by healthcare providers to PIP insurers, or the amounts that PIP insurers choose to reimburse providers.”

As I’ve blogged about before, we as Florida drivers have no choice but to pay for PIP under state law. Often we pay 20 percent or more of their overall car insurance premium for $10,000 in coverage for injuries in a car wreck, regardless of who is at fault.

A bill filed in the last week would let motorists opt out of PIP if they have health-insurance polices. Rep. Carlos Trujillo, R-Miami, filed HB 679 for the legislative session that starts March 3.

But insurers and hospitals have successfully lobbied against past efforts to abandon or weaken the state requirement to carry PIP. Most states require bodily injury liability insurance instead.

Groups representing hospitals say that PIP limits “have not kept up with inflation and the cost of healthcare generally,” said Linda Quick, president of the South Florida Hospital & Healthcare Association.

But the lawsuit claims charges have far exceeded what the hospitals bill for non-PIP customers. For example, Herrera went to JFK in Palm Beach County after a car accident last year, the suit says. The hospital billed $5,900 for a CT scan of her spine, $6,404 for a brain scan, $3,359 for a lumbar spine x-ray and $2,222 for a thoracic spine x-ray, according to plaintiffs. In contrast, Florida Medicare rates for an x-ray of the lumbar spine with four views are approximately $50 – meaning the hospital charge was 65 times higher, the suit claims. All told, the hospital charged close to $18,000 for radiological services for which Medicare pays less than $500 combined, the suit asserts. Herrera was left with a hospital bill for $6,500 in charges not covered by PIP and forced to pay $4,000 out of pocket for other treatment, the suit said. Her charges “would have been covered in full or in part by her PIP benefits if not prematurely exhausted by the exorbitant and unreasonable amounts of the hospital’s charges,” the suit claims.

It will be interesting to see if the court dismisses this cases or lets it move forward. I would like to see it move forward.



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