Alabama Personal Injury Blog - Representation

Why are Medical Bills so High?

Jon Lewis — Sat, 05 Dec 2009 13:49:34 GMT

Did you know that hospitals and physicians rarely ever receive the amount they charge for their services? Health insurance companies do not pay the actual bills invoiced by medical professionals. Why is that?

We had a client who was injured in a truck collision. His injuries were serious enough to warrant several nights in the hospital and a couple of surgeries. What were his medical bills? Approximately $72,000.00. What did the hospital and physicians get paid? $11,714.01, approximately 16% of the amount billed.

If you had a retail store, would you accept 16% of your prices? Why do hospitals and doctors? Are they over-charging, or are they getting paid too little?

What if you don't have health insurance? What happens then? Well, I can tell you that I handled collections for a hospital about 13 years ago, and if patients came in for emergency treatment and didn't have insurance, we sued them for the full amount, not 16%. Why do private pay individuals have to pay the full amount? I understand why health insurers receive a discount, but an eighty-four percent (84%) discount? What if Bill Gates doesn't want to get health insurance? He can pay any amount billed so why doesn't he receive the same discount as a company like BlueCross?

Is this a form of fraud or misrepresentation? In Alabama, BlueCross BlueShield has such a monopoly on health insurance that they dictate to hospitals and physicians what they can charge for their services. Many doctors speak poorly of BlueCross BlueShield as a result of their influence. Some won't even accept their rates as a result. Should the health insurance companies be setting the rates for medical treatment? Is that capitalism?

I don't have the answers to all these questions, but I think they need to be discussed, especially in light of healthcare reform. What are your thoughts?

Originally posted at InjuryBoard by Jon Lewis

Is it Fraud?

Jon Lewis — Wed, 15 Jul 2009 18:30:47 GMT

What is fraud? What is misrepresentation? Many people think they have been defrauded when they have not, and many people don't know that they have been defrauded when they actually have been.

In Alabama, fraud is statutorily defined and interpreted by case law. The statute is as follows:

Section 6-5-101

Fraud - Misrepresentations of material facts.

Misrepresentations of a material fact made willfully to deceive, or recklessly without knowledge, and acted on by the opposite party, or if made by mistake and innocently and acted on by the opposite party, constitute legal fraud.

(Code 1907, §4298; Code 1923, §8049; Code 1940, T. 7, §108.)

As you can see, fraud can be made by mistake and innocently, but if you rely on the mistaken misrepresentation, it constitutes fraud. In addition, silence can constitute fraud:

Section 6-5-102

Suppression of material facts.

Suppression of a material fact which the party is under an obligation to communicate constitutes fraud. The obligation to communicate may arise from the confidential relations of the parties or from the particular circumstances of the case.

(Code 1907, §4299; Code 1923, §8050; Code 1940, T. 7, §109.)

Of course, the issue in these cases centers around what constitutes "material". Typically, this can arise when there is a fiduciary relationship between the parties.

There are numerous elements to fraud. Not only does one have to prove that there was misrepresentation of a material fact, but you have to show some form of reliance. In other words, you have to rely on the misrepresentation and act to your detriment. Then, you must show that you have been damaged in some form or fashion.

How does this work? Well, I have a case right now where my clients purchased a home. The contract showed that the home was on a sewer. The seller and agent checked the box showing that it was on a sewer. They didn't know that it wasn't on a sewer, but they represented, in writing, that it was on a sewer. My clients bought the house. After a year, the clients find out that the home was not on a sewer or septic system. It was tied to an underground well. They had to pay a plumber to come out and connect the home to the sewer lines.

In this case, the seller misrepresented that the home was on a sewer system (even though it was innocent, and they didn't know). My client relied on the representation and bought the house at a certain price (they wouldn't have paid the same amount if they had known there was no sewer or septic system). They were damaged in that they had to pay to have the line dug up and connected to the sewer. That is a fraud and misrepresentation claim in Alabama.

Originally posted at InjuryBoard by Jon Lewis

How Can I Help My Friends or Family Find a Good Lawyer?

Greg Cusimano — Fri, 03 Jul 2009 10:19:29 GMT

When you, or someone you are close to, has been hurt or injured, it can be a very rough and troubling time for everyone involved. Legal representation, or finding a lawyer, is the last thing on anyone’s mind; however it should be one of the first.

For some the thought of contacting a lawyer can send shivers down spines, and bring thoughts of black briefcases, black suits, and even blacker hearts, but you can be assured that this stereotype of the legal profession is just that. A stereotype. This image of the rule bending, untrustworthy lawyer that sees you as nothing but a walking dollar bill, just simply isn’t the truth for most lawyers. Maybe a few, but not many. The few may be responsible for the bad image promoted by big money wrongdoers that don‘t want you to trust ANY lawyers. Because of the few, it is important you do your home work.

The truth is that most lawyers are willing to help you in your time of need and see to it that your rights as guaranteed by this nation are protected. Lawyers are specially trained to have the knowledge and details of the law that most lay-persons are not expected or required to have, and this knowledge can help you, the client, in gaining appropriate justice in many circumstances.

Some might be intimidated or impressed by the multitude of park benches, billboards, and TV ads, that depict a lawyer yelling in a court room, throwing a legal book on a desk, or even boxing a heavy bag. However, don’t be quick to dial the easiest number that you come across or the catchiest jingle. Lawyers, although usually competent in many areas of law, should have a specialty that will suit your needs specifically. It’s not always the best idea to go after the biggest firm, or the most impressive commercial.

Most lawyers are referred by word of mouth. This means that the people that are referring you to them have had direct contact and experiences with them. This is a great way to get a feel of what the lawyer is like, and how he (or she) conducts cases. Most legal problems that the normal person will run across are auto accidents, workers compensation, criminal charges, or other tort actions (such as slip and falls). For these situations, word of mouth in the community will be a good starting point to find your way around. However, what happens if you need to know how to set up a business in China under the Delaware Corporation Code? You might need a specialist that your neighbor can’t’ suggest. For this there are a multitude of lawyer referral services available online, including this blog you are viewing right now. Get started by browsing by location, or searching for a topic or practice area of interest or importance to you.

When you have finally arrived at whom you would think can give you appropriate representation, you should, or the lawyer will organize an introductory meeting for the two of you. Often there will be no charge to you, or a minimal fee. You may also be able to discuss your problem over the phone for no charge. This is all dependent on the lawyer and the firm you are dealing with. Remember that you are assured confidentiality in all of these discussions. Make sure that you are confident in your lawyer, and feel free to “shop around” a bit. Taking the time to go to two or three lawyers so you can make an informed decision will help you and your representation in the long run. Don’t be tricked by flashy ads, catch phrases, or large mahogany desks and rows of book shelves.

As always, take the time, make an informed decision, and be confident in your lawyer.

Originally posted at InjuryBoard by Greg Cusimano