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NC healthcare system overbills patient 11-fold for CT scan, hit with lawsuit

by John R. Fischer, Senior Reporter | March 01, 2022
Business Affairs CT X-Ray

Cansler is seeking for the court to order Vidant to reimburse Eastern North Carolina residents who are overbilled and to cease its surprise billing and debt collection practices.

In response, Vidant Health said that Cansler’s claims do not align with its care objectives of providing “patient centered, mission driven, not-for-profit values. In addition to a dedicated team of case managers who help patients understand their bills, set up payment plans and provide charity care in all applicable cases, Vidant has transparent pricing resources available online for any patient or prospective patient to reference,” said the nine-hospital system in a statement.

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Hospitals list their charges for procedures on chargemasters, which were not accessible to the public until recently. Uninsured and out-of-network patients are often responsible for the gross charges. For a pelvic CT scan at Vidant hospitals, these range from $1,727 to $4,996 in 2021, according to the complaint, while the Medicare reimbursement rate is $315.

North Carolina has some of the highest healthcare costs in the U.S. According to a RAND Corporation study, commercial insurers paid hospitals 247% of what Medicare would have for the same services in 2018. And last August, a group of residents in the state accused another organization, HCA Healthcare, of creating a monopoly in Western North Carolina.

It said in a class action lawsuit that HCA used “all or nothing” negotiation tactics to drive up healthcare prices and insurance premiums in Buncombe and Madison counties.

As of January 2021, hospitals are required to list the pricing for certain services they offer on their website. In 2020, the U.S. government also passed the No Surprises Act, which limits what patients owe financially to emergency or nonemergency care providers out-of-network (OON). In October 2021, the Biden administrationissued an interim final rule for the act which dictates that out-of-pocket expenses for a patient be similar to what they would pay a provider in-network.

Organizations like ACR opposed the new rule for its impact on the independent dispute resolution process. “Making a health plan’s calculated ‘qualifying payment amount’ — which does not reflect real world payment rates — the primary factor in independent dispute resolution arbitration will cause large imaging cuts and reduce patient access to care, regardless of their insurer,” Dr. Howard Fleishon, FACR, chair of the ACR Board of Chancellors, said in a statement.

The complaint was filed in the U.S. District Court for the Eastern District of North Carolina.

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