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Washington Regional Medical Center Pursues Insured Patient for Higher Charges Class Action

This class action takes on another practice of the convoluted US healthcare system in which injuries sustained in a car accident may not be paid for by the injured person’s medical insurance. The complaint claims that plaintiff Curtis Randolph was treated at Washington Regional Medical Center (WRMC), a hospital within his insurer’s network, but that the hospital did not go to the insurer for reimbursement but instead pursued Randolph, sought funds from his auto insurer, and filed a lien filed on his potential personal injury recovery from the accident. 

The class for this action is

  • All persons who, 
  • Between October 1, 2013 and October 1, 2018, 
  • Received any type of healthcare treatment from WRMC, 
  • While the persons were covered by health insurance policies which required WRMC to provide treatment at the agreed-upon rates and to submit their claims to the insurer for payment,
  • Whose bills were not submitted to the insurer and instead WRMC obtained payment from the patient, from an auto insurer, or from the patient’s third-party tort recovery.

Randolph was in an accident on October 27, 2014 and was taken to WRMC for emergency medical treatment. The charges for this treatment totaled $12,803.75.

At the time, Randolph was covered by an insurance plan written by USAble Mutual Insurance Company, which does business as Arkansas Blue Cross and Blue Shield. He presented his insurance information to WRMC. According to the complaint, WRMC requires patients to sign an assignment of insurance benefits that allows WRMC to bill insurers directly and receive payment directly from the insurers. 

WRMC has a provider agreement with Randoph’s insurer, the complaint says, so that treatment at WRMC is in-network. This means, the complaint says, that WRMC has agreed to a schedule of payments with Randolph’s insurer and that Randolph is only required to pay the applicable co-pay, co-insurance, and deductible. With a covered provider, the complaint says, there should be no “balance billing” or additional bills that require payment by Randolph.

However, the complaint alleges, WRMC refused to submit Randolph’s bills to the insurer. Instead, the complaint says, in order to get more than the reduced rates it had negotiated with the insurer, it decided it should get payment from Randolph, his auto insurance, or the party who caused Randolph’s injuries. This last it achieved by filing a lien on Randolph’s recoveries from his injury.

WRMC is the main defendant in this case, but its name is followed by a long list of health insurers in the region, including Randolph’s own. (Click on the complaint, below, for the full list.) The complaint alleges violations of Arkansas’s Deceptive Trade Practices Act, tortious interference with a contractual relationship, and unjust enrichment.

Article Type: Lawsuit
Topic: Insurance

Most Recent Case Event

Washington Regional Medical Center Pursues Insured Patient for Higher Charges Complaint

October 1, 2018

This class action takes on another practice of the convoluted US healthcare system in which injuries sustained in a car accident may not be paid for by the injured person’s medical insurance. The complaint claims that plaintiff Curtis Randolph was treated at Washington Regional Medical Center (WRMC), a hospital within his insurer’s network, but that the hospital did not go to the insurer for reimbursement but instead pursued Randolph, sought funds from his auto insurer, and filed a lien filed on his potential personal injury recovery from the accident. 

washington_regional_complaint.pdf

Case Event History

Washington Regional Medical Center Pursues Insured Patient for Higher Charges Complaint

October 1, 2018

This class action takes on another practice of the convoluted US healthcare system in which injuries sustained in a car accident may not be paid for by the injured person’s medical insurance. The complaint claims that plaintiff Curtis Randolph was treated at Washington Regional Medical Center (WRMC), a hospital within his insurer’s network, but that the hospital did not go to the insurer for reimbursement but instead pursued Randolph, sought funds from his auto insurer, and filed a lien filed on his potential personal injury recovery from the accident. 

washington_regional_complaint.pdf
Tags: Charges in Excess of What Was Promised, Health Insurance, Medical Care