Mr. Mohlman primarily represents people that have suffered injuries caused by car, truck and motorcycle wrecks, a wrongful death, dangerous property, and electrical shock. Mr. Stipetich also handles personal injury cases, but his primary practice is devoted to representing workers in employment matters, including wrongful termination, discrimination/retaliation, worker’s compensation, and wage and hour litigation.
A situation that is confronting an increasing number of our clients who have been injured in car wrecks and other accidents involves hospitals refusing to accept health insurance. The reason hospitals do this is to potentially get a bigger pay day by placing a lien against any settlement the victim ultimately receives. This article discusses some of the recent developments related to this bad behavior that is driven by corporate greed.
By STEVE EVERLY
The Kansas City Star
Jonathon Layden was once confident that if he were ever injured, he could count on his health insurance to help pay his medical bills.
“They’re going to come after you any way they can,” said Layden, who is suing Research for not submitting the bill to his health insurer. “It’s all about the money.”
When hospitals turn down your health insurance, they are then able to avoid the discounted charges they have agreed to with health insurers. In Layden’s case, the hospital went directly to him for the full bill, but the usual practice around the country is to go after whatever money a person injured in an vehicle accident might get from an auto insurance settlement.
Here’s how the practice usually works:
• The hospital first refuses to submit your bill to your health insurer.
• It calculates your bill without the health insurer discounts and instead files a lien against whatever settlement you might receive from an auto insurer.
• The hospital gets paid from the settlement.
In Layden’s case, the hospital allegedly didn’t even file a lien and instead demanded payment directly from Layden before a car insurance settlement was in hand.
A spokeswoman for Research would not comment, citing the ongoing litigation. HCA, the owner of Research and one of the nation’s largest hospital chains, also declined to comment. The hospital in its initial legal brief in the court case denied the allegations. Practice is growing
No figures are available to show how often bills aren’t submitted to health insurance. But the practice is thought to be growing because hospitals are looking for new sources of revenue as health care reforms seek to curb costs. That hospitals are tapping auto insurance settlements is not new. In state laws dating back to the Great Depression, they got the right to place liens on injury judgments and settlements. Hospitals were struggling financially because of a growing number of patients unable to pay. The liens were seen as contributing to the public good by helping the hospitals stay open and treat patients.But critics say in recent years that the liens have morphed into a tool to help maximize hospital revenues by getting more out of patients with health insurance.Kenneth Berger, a South Carolina lawyer, said that in the last two years, it has become an epidemic in his state.
“This is something that really does add insult to injury,” he said.
In this region, Research Medical Center and St. Luke’s Hospital in the Kansas City area and SSM DePaul Health Center in Bridgeton, Mo., are facing lawsuits against the practice. The three cases seek class action status to represent other patients who may have been affected.
Kerry O’Connor, a spokeswoman for St. Luke’s Health System, said in an email response that filing liens on injury settlements is expressly authorized by a Missouri statute and that other hospitals in the state are doing it as well. O’Connor said, however, that the hospital is not “asserting” new liens pending resolution of the court case. She added that St. Luke’s is assuming the risk of not being paid anything if there isn’t an auto insurance settlement. And it still contends it didn’t have to file health insurance for the person now suing the hospital.
Ralph Phalen, one of the attorneys representing patients in the suit against St. Luke’s, disagrees: “It’s our belief the contract (with the health insurer) requires them to accept.” In some other states, the practice has suffered legal setbacks dating to the late 1990s. But an Illinois court ruled it was legal.
The most public rebuke to the practice occurred in Indiana. Hospitals there were either not filing insurance to collect the gross charge or filing it and then using liens against auto insurance settlements to recover the part of the bill lost to the discounts. Earlier this year, the legislature approved a bill stopping it with large bipartisan majorities, and a conservative governor signed it. The new law went into effect July 1.
Alan Smith, director of the Midwest office of R Street Institute, a think tank based in Washington, called the Indiana move praiseworthy. The state won a skirmish in the battle to make medical bills more reasonable and to help vulnerable patients, he said.
“I can’t believe they (the hospitals) thought they could get away with this.”
The practice puts patients in the middle of disputes over medical bills that they thought would be paid with health insurance. Auto insurance settlements can indeed help pay the hospital bill in many instances, but the inflated cost without the health insurer discount can take an outsize chunk from a pot of money that is also used to cover other expenses, such as lost wages, attorney fees and replacement vehicles. Auto insurance policies have limits on how much they will pay in a settlement. In some cases in other states, hospitals have submitted bills worth more than the settlement. Auto insurers have a budding concern that because they don’t have the power that health insurers have to impose discounts, more of the medical costs will be shifted to them. That could end up boosting auto insurance premiums.
“It’s a significant issue,” said David Corum, vice president of the Insurance Research Council, a nonprofit group supported by such insurers as Allstate and State Farm. Specialized companies are helping hospitals sidestep the discounts.
In its sales pitch to hospitals, Medical Reimbursements of America, based in Brentwood, Tenn., says that while accidents represent just 2 percent of claims, they can generate higher reimbursement rates than any other category. The company contends that its AcciClaim Auto system ensures that hospitals get more when treating those injured in auto accidents, often 100 percent of the gross charges. The company recently formed an alliance with Firstsource Solutions of Louisville, Ky., which has employees stationed in emergency rooms and admissions offices at 300 hospitals across the country. Part of their job is to identify and interview auto accident victims. It was Medical Reimbursements of America that sent a letter to Britanie McKeever telling her that SSM DePaul Health Center in the St. Louis area would file a lien on any settlement gained from the other driver to pay her $31,000 hospital bill. Her attorney got the bill slashed, but she was shocked that her health insurance didn’t come into play.
“I thought I had full-coverage health insurance,” she said.
SSM DePaul said in a statement that it follows all state and federal guidelines and any requirements set forth by insurance agreements. When treating a person who has been involved in a motor vehicle accident, it works with the patients to identify all sources of insurance payers.
Kansas City area cases
Layden didn’t discover that Research wouldn’t be using his health insurance until more than a month after his accident. His initial bill actually showed the $10,896 bill dropping to $3,281 after an adjustment for the insurer’s discounts. He called the hospital asking if the bill had been sent to Blue Cross but didn’t receive an answer. Soon after, he received a $10,896 bill, the amount without the discounts. The hospital eventually sent his account to a debt collection agency, which agreed to cut the bill in half. Faced with a falling credit rating, Layden got the loan from his parents. The hospital ended up getting about $2,000 more by not submitting the claim to the health insurer. The physician who treated him in the emergency room submitted his bill to Blue Cross.
“It’s time for them (Research Medical) to take responsibility for their actions,” said Layden, who eventually received a $14,000 auto insurance settlement. A spokeswoman for Blue Cross Blue Shield said hospitals it contracts with, including Research Medical, are required to submit a claim. When the issue appeared in the Kansas City area isn’t clear, but it has been simmering for years.
“It seems to have started (in the Kansas City area) five or six years ago,” said Mitchell Burgess, a lawyer with the Kansas City firm Burgess & Lamb, who is representing patients who have filed lawsuits, including against St Luke’s. St. Luke’s has gotten a Kansas case dismissed, but it received mixed rulings in others.
In 2009, Iretta Morgan was in a car accident and was taken to a St. Luke’s hospital. The hospital submitted an $11,452 bill to her health insurer, which paid a discounted amount. The hospital sent the check back to the insurance company and filed a lien against any settlement Morgan received. In Jackson County Circuit Court, St. Luke’s argued that Missouri’s liens law gave it authority to use it on health insurance patients. It rejected arguments that it was unjustly enriching itself by seeking to recover the medical bill without the discounts. The judge agreed, handing St. Luke’s a victory.
Morgan appealed her case to the Missouri Court of Appeals. It ruled the hospital didn’t have unfettered rights to use the liens to collect a higher bill. Instead, the case hinged solely on whether the hospital was required to submit the health insurance and accept the discounts that satisfied the debt. The case was sent back to Jackson County Circuit Court to determine if the hospital’s contract with the health insurer did require a claim to be filed. It is still pending. St. Luke’s said the appeals court merely held that the plaintiff is entitled to review the insurance contracts.
“Yes, St. Luke’s contends it was not required by contract, nor by law, to submit the claim to the insurer,” the hospital said in an email response to a question.
Aetna, the health insurer for Morgan, did not return a call seeking comment, but her attorneys say they have seen enough hospital contracts with insurers to be confident there is such a requirement. Indiana Sen. Brent Steele, a Republican who sponsored the bill reining in the hospitals in his state, said the legal arguments may be beside the point. In Indiana, liberals and conservatives, Democrats and Republicans, and even trial lawyers and insurance companies united to stop the practice. The medical treatment by the hospitals wasn’t questioned, but by sidestepping the health insurance they were making up their own rules. He said their attitude reminded him of a scene in the Mel Brooks movie “History of the World, Part I.”
A king was playing a game of skeet, but instead of clay discs, he ordered live peasants catapulted into the air to shoot. He turned to an adviser and said: “It’s good to be the king.”
Missouri and Kansas personal injury law firm Smith Mohlman Leroy, LLC, is proud to announce the inclusion of lawyers Rachel Smith, Mike Mohlman and Michael Stipetich in this year’s Missouri and Kansas Super Lawyers list. Super Lawyers is a service that rates outstanding lawyers who have attained a high degree of peer recognition and professional achievement.
Ms. Smith and Mr. Stipetich have been named Missouri and Kansas Rising Stars as top up-and-coming attorneys. No more than 2.5 percent of the lawyers in any state are chosen as Rising Stars, and selection to this list is made by the research team at Super Lawyers. Ms. Smith has been named a Rising Star every year since 2009. This is the first year that Mr. Stipetich has been included.
Mr. Mohlman has been named to the Missouri and Kansas Super Lawyer list as one of this year’s top attorneys in Missouri and Kansas. No more than 5 percent of the lawyers in any state are selected as Super Lawyers. Selection to the Super Lawyer list is made by using a statewide survey of lawyers, an independent research evaluation of candidates, and reviews by other lawyers. Mr. Mohlman has been listed as a Super Lawyer since 2009.
Ms. Smith and Mr. Mohlman primarily represent people that have been injured through no fault of their own. They focus their practice on serious injury cases caused by car, truck and motorcycle wrecks, wrongful death, premises liability and electrical shock. Mr. Stipetich also handles personal injury cases and other tort cases, but his primary practice is devoted to representing workers in employment matters, including wrongful termination, discrimination/retaliation, worker’s compensation, and wage and hour litigation.
Smith Mohlman Leroy, LLC is moving to the Country Club Plaza on January 1, 2013. We have signed a lease for 5600 square feet of space on the 7th floor of the Plaza West Building at 4600 Madison, Kansas City, Missouri. We are all very excited about the new office which will provide us more space and better facilities as well as the latest in technology in order to better serve our personal injury and business clients in Kansas and Missouri. We will be providing more information as the move grows nearer. In the meantime, come see us at our current office at 7001 W 79th St., Overland Park, Kansas 66204.
Smith Mohlman Leroy is proud to announce that Rachel Smith was
selected as one of the Missouri Lawyers Weekly “Up and Coming
Lawyers”. These lawyers were selected because they go above and
beyond in the legal profession for 2012. Attorneys were selected
based on their contribution to the legal profession in their
Rachel has been active in many philanthropic organizations
in Kansas City including spending eight years on the board of Big
Brothers Big Sisters, co-founding Smith Mohlman Leroy Kids
Foundation, and supporting many, many others. She is a dedicated
personal injury attorney who handles a wide range of negligence cases,
including car, truck and motorcycle wrecks. She is devoted to her
clients, and to promoting community safety. She has obtained
significant recoveries for her clients, most recently a case involving
a child on an ATV, and a museum patron who had his fingers severed by
a defective and misused door.
Smith Mohlman Leroy, LLC is pleased to announce that founding partner Rachel Smith has been named to the Kansas City Business Journal’s list of Women Who Mean Business for 2012. Each year the Business Journal selects 25 women from all types of businesses in the Kansas City metropolitan area. These women are selected by a panel of judges as being outstanding for their business accomplishments, growth plans for their companies, contributions to the community and efforts to improve the climate for women in business. Rachel and this year’s other honorees now join 300 other women selected over the past 12 years to join this elite group of business women.
Rachel founded the firm in 2005 with the goal of assisting clients who have suffered personal injury accidents through the fault of others and in handling small business matters with an emphasis on litigation. They were joined by Rachel’s former classmate Mike Mohlman in 2011 who brought experience in complex personal injury cases from Independence to Overland Park. The firm now has six attorneys and practices on both sides of the state line. If you have personal injury or business related legal issues in Kansas City, KS or surronding areas, come see Rachel. She means business.
In November, Missouri voters will be asked to make changes to the way many of the state’s top judges are chosen. Known colloquially as the Missouri Plan, the rules, originally adopted by voters in the Show-Me State in 1940, have served the state well.
Under the Missouri Plan, commissions of lawyers and gubernatorial appointees nominate three finalists for open seats on the appeals and supreme courts, along with judges in urban judicial circuits. The governor picks one of the three. The process, while not perfect, minimizes political influence.
A group of deep-pocketed Republicans who would prefer to buy Supreme Court judges in expensive elections convinced the Legislature this year to ask voters to tweak the plan. The proposal on the November ballot is not nearly as bad as previous ones, but it would further politicize the selection of judges by giving more power to the governor.
Last week, some of those opponents of the Missouri Plan said that a decision by the Missouri Supreme Court striking down damage caps in medical malpractice lawsuits supported their case. The way folks like Lt. Gov. Peter Kinder and lobbyist James Harris see it, the medical malpractice decision is proof positive that trial attorneys — who file malpractice lawsuits on behalf of aggrieved victims — have outsized influence in choosing judges. The 4-3 decision was the judges paying back their supporters, they say.
Expect similar allegations to be made in political advertisements this fall. Here’s what voters will need to know:
The allegation is laughable.
Missouri’s is not the only state supreme court to have overturned medical malpractice caps. Seven other state supreme courts have overturned similar medical malpractice caps in their states on almost identical legal grounds: Arbitrary caps limit a citizen’s right to a jury trial. Other states have specific constitutional prohibitions against such caps.
It’s easy to understand why. Our nation’s Founding Fathers thought it was important to preserve the right for all of us to be judged by a jury of our peers. That is often our final protection against the potential tyranny of the state, a state that often in our nation’s history has been influenced by corporate barons.
But with medical malpractice caps in place, here’s what can happen: Patients, or broken-hearted survivors, find a lawyer to sue doctors or hospitals that made preventable errors that led to serious harm or death. Lawyers take the cases on contigency — that is, they bear the considerable expenses of bringing the case in return for a percentage of damages, usually about a third.
If they lose, they get nothing. They can’t afford to take weak or frivolous cases. If there’s a cap on non-economic damages, it’s harder for injured parties to find a lawyer willing to bring a tough case.
Only a tiny percentage of cases make it to trial; most are settled out of court.
Fewer still end up with juries. Those jurors often shed sweat and tears over what’s right. They come to a number offering fair financial remuneration. They tell the judge.
In cap states, the judge thanks them for their service before they find out that they wasted their time. Lawmakers in the state capital already had decided what the number was. Much of their work was unnecessary.
Supreme courts in Illinois, New Hampshire, Washington, Oregon, Alabama and Georgia have overturned medical malpractice caps.
Not a single one of those states chooses its judges using the Missouri Plan. New Hampshire’s hybrid system comes the closest, but in the rest of the states, supreme court judges run for election in either partisan (Illinois and Alabama) or nonpartisan (Georgia, Oregon and Washington) contests.
We don’t think too many people are going to accuse liberal trial attorneys of having outsized influence in the selection of judges in Alabama and Georgia.
In fact, in 2003, the second and most recent time Alabama overturned medical malpractice caps, its chief justice was Roy Moore of the Ten Commandments-in-the-courthouse fame. Mr. Moore, a darling of the right, is no weak-kneed liberal.
So to say that trial attorneys and the Missouri Plan somehow led to the medical malpractice decision ignores reality. It’s a further example of how the campaign against the nonpartisan court plan is nothing but trumped-up political tomfoolery.
In fact, overturning medical malpractice caps is an old-fashioned conservative decision, protecting Missouri’s constitution and the basic right to a jury trial.
Standing up for “job creators” doesn’t make one a conservative; it makes one an opportunist or a plutocrat, or both. Thank goodness our Founding Fathers, and four sitting Missouri Supreme Court justices, knew the difference.
At Smith Mohlman Leroy, LLC. we enjoy keeping up with the latest legal news and sharing it with you. We firmly believe that is important to keep up with industry happenings because it is just one more way that we can help you. An unfortunate vaccination error results in the loss of four limbs for a Miami teenager, “idiot”insult in an email sent to 400 people sparks a lawsuit, and while the wrongful death lawsuits from the 2010 West Virginia mine explosion have finally been settled, it’s far from over for Alpha.These were some of the topics gracing legal headlines this week. As always, we thank you for reading. Have a good one!
1. Miami teenager loses limbs due to vaccination error. The teen, who lost all four limbs as a result of the expired vaccine, has recently been awarded $12.6 million in the lawsuit. However, an appeal is likely.
2. Take a deep breath before you fire off that heated work email. A housing inspector has filed a civil against a real estate agent and her company after the real estate agent called him a “total” idiot in an email sent to more than 400 people.
3. It’s far from over for Alpha Natural Resources. The 2010 West Virginia mine explosion claimed the lives of 29 men. Nearly two years later, the wrongful death lawsuits filed by the families have been settled. But after acquiring Massey Energy for $7.1 billion, it also acquired a civil lawsuit filed by Massey Shareholders.
Thank you for reading. Have a great Friday!
At Smith Mohlman Leroy, LLC. we enjoy keeping up with the latest legal news and sharing it with you. We firmly believe that is important to keep up with industry happenings because it is just one more way that we can help you. A bungee jumping disaster of crocodile-infested waters, a 5-year-old girl who might be healthy today with an earlier diagnosis, current Kansas legislature issues and the anti-clotting drug Pradaxa. These were some of the topics gracing legal headlines this week. As always, we thank you for reading. Have a good one!
1. Snapped bungee sends a 22-year-old girl plunging into crocodile-infested waters. The Australian tourist was bungee-jumping in Zimbabwe when disaster struck. She amazingly managed to swim to safety with a broken collarbone and her legs tied together. MSNBC has secured video footage of the jump.
2. Minnesota Court Appeals examines the possibility of a late diagnosis. Five-year-old Jocelyn has been battling a rare and aggressive form of cancer muscular cancer for most of her life. The issue being looked at by the court is whether or not she would be healthy today if she had been diagnosed earlier. What’s different in Minnesota? The legality of medical malpractice suits are linked to the patient’s chances of survival.
3. The Kansas Legislature is now in session. The Kansas City star has compiled a list of some of the key issues up for discussion. The session began on Monday.
4. Issues have been reported with anti-clotting drug Pradaxa. The blood clot prevention drug has been associated with a slightly higher risk of heart attack, said a recent study in a major medical journal. The relative increase in risk ranges from 27 to 33 percent.