What is the name of your state (only U.S. law)? Texas
This is all in Texas.
I went to the ER with insurance. However the emergency insurance had various caps and deductibles and I am left with about $7,000 in bills. I have attempted to negotiate with the hospital, but they won't budge. I have researched the procedures, tests, etc that the hospital charged and have found them to be many times the Medicare rate and considerably more than the medical blue book rate for the same services in my area. I would like to pay the bill, and have offered to pay a number above but closer to what the medical blue book site suggests and have been rebuffed. I'm sure various users will have opinions on my situation, however I ask that commentary be restricted to my specific legal question:
My understanding is that if we do not reach an agreement that the hospital will (have the option to) sue me for breach of contract under the "sworn accounts" procedure (TRCP 185). My understanding is that an element of establishing a "sworn accounts" case is that the (in the absence of a written agreement on price) prices are to be "usual, customary, and reasonable." My question is can you point me to case law interpretation of these terms? Specifically, to what extent can I challenge the claim on these grounds? Would this question be left for the jury to deiced (or be decided by the judge as a matter of procedure early in the trial)?
More informally: Consider the following: I make the hospital an offer which seems to be the range of what other hospitals are charging in the area for the same service (which I can make a documented case for), and they decline it and sue me. If I try to proceed under the position that I received the services, acknowledge I should pay for them, but disagree that the prices are reasonable and customary, what is likely to happen in the case? If i did go this root would I be able to discovery documentation regarding price practices, etc?
To the extent possible please point to specific examples, case law, procedures, etc.
Thank You.
(PS. Yes, I know I might want to talk to a lawyer.)
This is all in Texas.
I went to the ER with insurance. However the emergency insurance had various caps and deductibles and I am left with about $7,000 in bills. I have attempted to negotiate with the hospital, but they won't budge. I have researched the procedures, tests, etc that the hospital charged and have found them to be many times the Medicare rate and considerably more than the medical blue book rate for the same services in my area. I would like to pay the bill, and have offered to pay a number above but closer to what the medical blue book site suggests and have been rebuffed. I'm sure various users will have opinions on my situation, however I ask that commentary be restricted to my specific legal question:
My understanding is that if we do not reach an agreement that the hospital will (have the option to) sue me for breach of contract under the "sworn accounts" procedure (TRCP 185). My understanding is that an element of establishing a "sworn accounts" case is that the (in the absence of a written agreement on price) prices are to be "usual, customary, and reasonable." My question is can you point me to case law interpretation of these terms? Specifically, to what extent can I challenge the claim on these grounds? Would this question be left for the jury to deiced (or be decided by the judge as a matter of procedure early in the trial)?
More informally: Consider the following: I make the hospital an offer which seems to be the range of what other hospitals are charging in the area for the same service (which I can make a documented case for), and they decline it and sue me. If I try to proceed under the position that I received the services, acknowledge I should pay for them, but disagree that the prices are reasonable and customary, what is likely to happen in the case? If i did go this root would I be able to discovery documentation regarding price practices, etc?
To the extent possible please point to specific examples, case law, procedures, etc.
Thank You.
(PS. Yes, I know I might want to talk to a lawyer.)