Maryland Injury and Disability Law : Washington DC Metro Injury & Disability Lawyer & Attorney : Greenberg & Bederman : Accidents, Falls, Medical Malpractice : Maryland, DC, Virginia

The Heathcare System and Medical Bills

Perhaps one of the saddest things about our healthcare system is that there is an occupation dedicated towards correcting what hospitals and insurance companies get wrong. And it isn’t the lawyers, believe it or not.

There are people out there called “medical billing advocates,” and their job is twofold: First, they make sure that all medical charges from the hospital are legitimate, and secondly, they help convince insurance companies to pay for medical claims that were denied for no good reason.

Most of them don’t charge by the hour. Just like injury attorneys, they charge as a fee a percentage of the money that they save you. While we are glad that such a position exists, we think it’s quite sad that they have to be in business at all. We are equally sad that business is apparently booming for them.

According to a group called the Medical Billing Advocates of America, there are errors on fully 80% of medical bills. And by “errors” they don’t mean mistakes in spelling in punctuation. We mean charges that are made that shouldn’t be there.

There are duplicate charges, price gouges, and “creative rebranding” of standard things in order to make them seem more expensive than they really are. For instance, one bill that was scrutinized listed a box of tissues as a “mucus suppression system.” A box of tissues at the average grocery store will run you $2.00. But a “mucus suppression system at the local hospital will run you $30.00. A second bill that was scrutinized charged some poor child $100.00 for the use of a teddy bear, which was billed as a “cough support system.” A single Tylenol, which is listed as “pain relief therapy”can cost you about $25.00.

Overnight stays also provide a billing bonanza for hospitals. Normally the room is supposed to have a flat rate, just like in the Holiday Inn. But quite often you will see surcharges for sheets, bedding, heating and/or cooling costs, extra blankets, and the electricity that it costs to run the television/adjustable bed/heart monitor.

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The Reddest Herring in the Health Care Debate

It’s impossible to turn on the news without coming across the angry crowds at these town meetings. The national temper is certainly hot. And while we can certainly concede that there are some valid arguments to be made, we have noticed that quite a few of the arguments are based on deliberate half truths and misinformation, many of which seem to be pandering to the worst in us.

The most obvious of these would be the “death panels” argument, which essentially accuses the government of wanting to establish a policy of enforced euthanasia for the elderly and the terminally ill. There is also the rumor that health care reform will offer free medical care to illegal aliens, which is both untrue and a very convenient way to turn health care reform into a matter of race.

In comparison to these delusional rantings, some of the other arguments seem to be based on Planet Earth, but that doesn’t make them any more accurate. For instance, we are seeing more and more “Tort Reform Now!” placards showing up at these town hall meetings, and while we prefer those vastly to the signs that show President Obama with a Hitler mustache, we can say with great certainty that, as it pertains to health care, tort reform is as much of a red herring as death panels or free care to illegal aliens.

What the tort reform people are demanding is caps on medical malpractice damages, which has about as much to do with your health insurance as fire insurance has to do with drowning. Medical malpractice insurance companies have absolutely nothing to do with Aetna, Blue Cross/Blue Shield or United Healthcare. The premiums that malpractice insurers charge doctors have absolutely nothing to do with the amount that you are paying for your health care premiums, and everything to do with the malpractice insurers maintaining healthy profit margins.

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The Sunshine Act – Who Does It Protect?

Lawyers of all types have to keep a lot of secrets.  That’s the nature of the business.  For the most part these secrets fall under what is called “attorney/client privilege,” and it certainly has its uses.  It’s difficult for an attorney to provide effective legal counsel unless their clients tell them everything.

But there are plenty of secrets that attorneys and their clients don’t want to keep at all.  There are some secrets that they think should be shouted from the rooftops, posted on billboards, advertised on television and plastered on the front page of every newspaper in the United States.  But in many cases, attorneys and their clients aren’t allowed to do any of these things.  And innocent people suffer as a result.

Here is a completely made up, pie in the sky scenario for you:  Let’s say for the sake of argument that a multi-billion dollar chemical conglomerate has released a new weed killer, specifically to be used by regular people in their home gardens.  Let’s call it “Product X.” Mrs. Smith (again, a totally made up person who does not really exist) purchases Product X and begins to use it at home.  It works wonders on the weeds in her garden, so she recommends it to all the members of her gardening club.  Five of the members of the gardening club purchase Product X and start using it vigorously.

Within a year, Mrs. Smith and all five of the members of the gardening club have been hospitalized with a chronic, debilitating illnesses.  Doctors are baffled until it is determined that all five of them started using Product X at the same time.  Testing determines that when used under certain conditions, Product X is actually a quite dangerous defective product.  It turns out that Mrs. Smith and her gardening club will all be stuck with hacking coughs and chronic weakness for the rest of their lives.

Mrs. Smith and her gardening club all file lawsuits against the multi-billion dollar chemical conglomerate for $5,000,000 a piece, and as a group they ask for $30,000,000 in punitive damages.  The chemical company files delay after delay, employing legal tactics that are known as “grinding it out,” which means filing appeal after appeal for every conceivable aspect of the lawsuit.  If there is a comma in a complaint that they don’t like the looks of, they will file for a continuance over that.  If the continuance over the comma is denied then they will appeal that.  If that doesn’t work then they will file for a continuance over the use of the word “Product” in the lawsuit, and if that is denied, they will appeal that.  And so on and so on.

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There has been a rather interesting development in the world of corporate and customer relations. About a year ago, a folk and country musician named Dave Carroll was flying to Nebraska on United Airlines. While waiting on the tarmac for his connecting flight at Chicago’s O’Hare airport, Mr. Carroll overheard a passenger behind him say “My God, they are throwing guitars out there!”

Quite rightly alarmed, Mr. Carroll then informed three airline attendants of his concerns, and was, in his words, “greeted with indifference.” When he landed in Nebraska, he found out that it was in fact his guitar that had been thrown around by the baggage handlers, and he found that it was broken as a result.

The guitar was a Taylor acoustic, which is one of the higher end brand of guitars that are currently made in the United States. The cost of an electric/acoustic model, which was what Mr. Carroll had in his possession, ranges between $1200 and $5000. They are not what you would call cheap guitars.

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In the current health care debate, we hear many of the naysayers use the argument that they don’t want “some faceless bureaucrat in Washington making decisions about our healthcare.” We find that argument strange, mainly because as things stand right now, decisions about your healthcare are made by a faceless insurance adjuster. The decisions aren’t based whether or not the treatment is what’s best for the patient, but rather on whether or not the insurance company is willing to pay for them. We have noticed that many of the scare tactics used by opponents of health care are simply recitations of the status quo. They aren’t creating the imagery of some Orwellian nightmare as much as they are simply shining a spotlight on how things currently are.

As an example, consider the case of James D, who suffered a broken leg.  At the time of his injury, he was an editor at the Washington bureau of a well regarded science magazine.  His employee health insurance was covered by United Health Care, which is one of the largest private medical insurers in the United States.

What was thought to be a straightforward injury claim turned into an 18 month odyssey in which James was facing $30,000 worth of denied medical bills.  Anyone who believes that health care coverage in this country does not need reforming should probably hear his story.

GB: Tell us about the circumstances of your injury.

JD: I slipped and fell and broke my leg in three places. That was all there was to it. This was during the winter, and it was snowing outside, and I thought I had salted the walkway to my house the night before as well as I could, but it seems that I missed a spot. That was the spot that I stepped on the next morning, of course. I stepped on some ice, and I fell, and there went my leg.

GB: That could have happened to anybody.

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Contingency Fees Give Legal Access to Those Who Can’t Afford It

Tort reform organizations want to do away with the contingency fee arrangement, which would take away legal access to the majority of our clients.

When we take on a client, we don’t take one penny from them up front. We don’t accept Visa, Master Card, American Express, the Discover Card, checks, money orders or cash. We don’t expect them to get loans or second mortgages on their houses to pay us.  We don’t expect them to get cash advances on their credit cards. We never put ourselves in a position to take anything up front from our clients.

The reason for this is because our clients have had plenty taken from them already. They usually have thousands of dollars in medical bills, and considering that many of them will be unable to return to work in the foreseeable future, they are often in no financial position to pay exorbitant up front  hourly legal fees.

What we do here at Greenberg and Bederman is offer our legal services on a contingency basis. What this means is that we will represent our clients’ interests in any negotiations or court proceedings, and the only way that we get paid is if our clients case is won. It doesn’t make economic sense to accept just any personal injury claim, so our business model is to accept only those cases we are pretty sure we can win.  If we get a settlement for our clients or come away with a successful judgment or verdict on their behalf, we usually take one third of what is recovered as payment (depending on whether it is pre or post litigation it may be up to 40%). This works to the benefit of the client, as this allows the disadvantaged client the opportunity to be represented against the large insurance companies who also have lawyers, and to help our clients collect everything they are entitled to under the law. In fact, our experience has shown that large insurance companies routinely deny or delay legitimate legal claims, and that’s WITH attorney representation. We can only speculate how the non-represented injury victim is treated by the insurance companies.

The American Tort Reform Association does not like the contingent fee system at all.  They would rather do away with the contingency fee system and have clients pay an hourly rate up front:

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Dram Shop Laws – Should We Have Them in Maryland, DC and Virginia?

Alcohol doesn’t grow on trees.  Nor is it sold in vending machines or hawked at lemonade stands. In order to buy alcohol, you have to walk into a bar or liquor store that has been licensed to sell it by the state. This is how it is in every state of the union.  

There is a good reason for this.  Alcohol is an intoxicating beverage, as we’re sure all of you are well aware.  In high enough doses, it can quite easily be fatal.  It seems that every year more and more teenagers or fraternity pledges find this out the hard way.  But even in less than fatal doses, alcohol still alters behavior and reflexes.  People who have been drinking often behave in ways that would never occur to them when they are sober.  And quite often, it isn’t just themselves they hurt.  Drunk people get into fights, or people abuse their significant others, people pass out in public places, people think it’s a good idea to walk along the hand railing of a bridge, etc. etc.

In short, alcohol is not something that should be easily available.  It should be as difficult as possible for those who are underage to get, and its sale should be forbidden to those who are already visibly intoxicated.  Those who sell alcohol should be fully aware of the unpredictability of those who drink it, and they should further be expected to sell alcohol in a responsible manner, whether they are bartenders or liquor store clerks.

It is because of these expectations that most states have what are called dram shop laws. The idea behind these laws is that if a bartender or liquor store owner continues to serve or sell alcohol to someone who is visibly and obviously intoxicated, then that bartender or liquor store owner should have to shoulder some of the responsibility when that intoxicated person causes damage, pain and suffering to others.

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