Lori Mill is an accountant. She's also one of an increasing number of people whose health insurance pays only 80 percent of her medical costs. So when she got a $1,133 bill for...
Lori Mill is an accountant. She’s also one of an increasing number of people whose health insurance pays only 80 percent of her medical costs.
So when she got a $1,133 bill for a 30-second procedure in Virginia Mason Medical Center’s downtown outpatient clinic — the doctor clipped her toenail and sent it to the lab to be tested for fungus — she read it carefully. And she started asking questions.
She learned that if she’d gone to a different Virginia Mason outpatient clinic, such as the Kirkland clinic, where her doctor also practices, the bill would have been at least $418 less — the amount included on her bill as “miscellaneous hospital charges.”
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Nobody at Virginia Mason told her any of this ahead of time, said Mill, who lives in Everett and works in downtown Seattle.
“When I’m paying 20 percent of that bill, if I had known about [the charges] up front, I would not have been in that downtown clinic,” she said. Virginia Mason refused to change her bill, Mill said, even after she asked her insurer’s fraud department to review the case. So Mill told her story to a lawyer.
Yesterday, John Phillips filed a lawsuit he hopes to have certified as a class action against Virginia Mason, alleging unfair and deceptive practices in charging patients more at one clinic than the other, and not telling patients ahead of time.
Also named as a plaintiff in the suit is DeLois Gibson, another insured patient who says she had virtually the same experience. After she had a small bump on her neck excised at the same downtown clinic, her bill for $1,451 included $846 for hospital charges, according to the lawsuit. Like Mill, she pays 20 percent of her medical bills, and says she was never warned that her choice of clinics would make a huge difference in the cost.
Patti Crome, Virginia Mason senior vice president and clinic administrator, said she was unable to comment specifically about the lawsuit because officials there had not had time to analyze it.
“We’re obviously taking this very seriously. We need some time to investigate what the issues are, and gather the facts,” she said.
In general, Crome said, “patients are our top priority, and we believe we bill them appropriately. We’re happy to talk with them about any concerns they might have about their bill or their care.”
Phillips, working in conjunction with a Mississippi lawyer who has pursued class actions against nonprofit hospitals across the country, filed lawsuits against two health systems in Washington and Oregon last year. Those suits alleged that uninsured patients pay inflated “sticker prices” for care, while insured patients get deep discounts.
He says the lawsuits signal a change in health care: Patients are having to learn to be consumers because “increasingly, as a population, they are being required to pay the costs.”
But for patients to be good consumers, Phillips said, health-care providers must give patients enough information to make choices.
And that, he said, rarely happens.
The American Medical Association, Phillips notes, has said that patients insured by Medicare who have surgical procedures done at hospital-based facilities “should be protected” from significantly greater charges than they would have received at non-hospital-affiliated centers. It also encourages consumer groups to inform patients of price differences “so as to facilitate informed choice of care.”
On its Web site, the Virginia Mason Seattle Main Clinic appears similar in every way but size and number of practitioners to the Kirkland clinic.
Mill was able to discover what the charge would have been if she’d gone to the Kirkland clinic only because she had the diagnostic code from her bill for the procedure, she said.
“Lori Mill is a pioneer in that regard,” Phillips said. “At minimum, it will make hospitals — this hospital — more transparent in their pricing. If you’re transparent, you have to be fair. Because you can’t be transparent and unfair for very long.”
Phillips brought the lawsuit under the Washington Consumer Protection Act, which could result in triple damages being awarded each patient in the class, up to a maximum of $10,000 per patient. He has a “standard” contingency-fee arrangement with the patients, he said. Attorney fees also could be awarded directly to him under the statute if the patients prevail.
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org