After a car wreck, Penny Wollmen said she had no idea a hospital’s scans to check for injuries would use up her $10,000 in Personal Injury Protection benefits in a single day. A chiropractor told her there were no benefits left to pay for his services under Florida’s car insurance system, she said.
“I was crying,” said Wollmen, who said she has four kids and has to drive her husband to work in their one remaining car. “I couldn’t get the proper treatment.”
A lawsuit scheduled for a hearing Tuesday names Gov. Rick Scott’s former company and alleges HCA hospitals including JFK Medical Center in Atlantis are exhausting consumers’ PIP benefits by grossly overcharging for services — at up to 65 times what Medicare pays.
Hospital attorneys have asked a federal judge in Tampa to dismiss the suit.
“We believe the case lacks merit, and we intend to defend it vigorously,” a statement from JFK Medical Center said.
With one motorist in Palm Beach County, JFK charged nearly $18,000 for scans for which Medicare pays a total of less than $500, the suit claims. The lawsuit seeks class-action certification to represent others affected at some 80 HCA hospitals around the state.
Win or lose, it’s a very different narrative than the debate about bad guys faking accidents or providing phony care that preceded 2012 PIP reforms. Scott personally lobbied for and signed a bill that helped focus payments on hospitals and other emergency providers by reducing nonemergency benefits to $2,500.
This lawsuit claims hospitals are the ones ripping off consumers and exploiting the system.
“They are purposely overcharging and thus taking the money from those needing the medical care and help,” said plaintiff attorney Theodore Leopold in Palm Beach Gardens.
Hospital attorneys say if drivers have a problem, they should take it up with their insurance company that agreed to pay the charges. They want the court to dismiss the case and reject a bid to make it a class action.
“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,” attorney Walter J. Tache of Miami and colleagues wrote in a court filing. “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.”
Florida drivers have no choice but to pay for PIP under state law. They often 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. The coverage is required no matter how much health insurance a driver already has — coverage that may or may not come with negotiated rates for hospital services that are lower than what PIP coverage provides.
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. Colorado drivers saved 35 percent on their overall premiums after their state dropped a no-fault system.
One problem is that Florida’s PIP benefits have changed little since the 1970s, groups representing hospitals say.
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. “What you can get for $10,000 is nowhere near what you used to be able to get for $10,000.”
HCA hospitals are not among her group’s current members, she noted. But she acknowledged federal officials have wrestled with sometimes wide variations between what hospitals may charge for diagnostic scans and what other providers may bill for the same services.
Some accountable care organizations, for example, have been rewarded for saving money while keeping Medicare patients happy — largely by reducing scans and stays in hospitals where possible.
In fairness to hospitals, they have to be ready to operate around the clock and keep the lights on with staff available to deal with emergencies, and those costs may be reflected in what they charge, Quick said.
But the lawsuit claims charges have far exceeded what the hospitals bill for non-PIP customers.
The suit has been brought by four Florida drivers, Marisela Herrera, Luz Sanchez, Nicholas Acosta and Wollmen. It names as defendants JFK Medical Center, Memorial Hospital Jacksonville, North Florida Regional Medical Center and HCA Holdings Inc.
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.
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.
Even for uninsured patients, JFK represents that it charges between $1,596 and $3,464 for a diagnostic CT Scan, according to the suit.
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.
Wollmen faced similar charges at another HCA hospital, North Florida Medical Center in Gainesville, the suit says. So did other plaintiffs around the state.
Hospital lawyers disagree, but Leopold sees a pattern.
“Nefarious conduct by the hospitals is gouging the system,” he said.
Example of what the PIP hospital suit claims
For a motorist covered by Personal Injury Protection insurance in Palm Beach County, JFK Medical Center charged for these radiological services, a lawsuit says:
$5,900 for CT scan of her spine, $6,404 for CT scan of her brain, $3,359 for lumbar spine x-ray, $2,222 for thoracic spine x-ray.
What the suit says Medicare pays, for comparison:
CT scane of cervical spine $213 to $220, brain $164 to $169, thoracic spine $40, lumbar spine $50
Total: Up to $479
Source: Marisela Herrera et al. v. JFK Medical Center et al.
MORE ONLINE: Check out Charles Elmore’s frequent updates on consumer news at protectingyourpocket.blog.palmbeachpost.com