Hospital Pricing Agreements Discoverable in Dispute Over Reasonableness of Georgia Hospital’s Charges

Ms. Bowden was an uninsured patient treated at a hospital in Columbus following a car wreck. The hospital billed her $21,410 for emergency treatment for a broken leg, and subsequent physical therapy, and then filed a lien for that amount against anything she might recover in a lawsuit arising from the wreck under Georgia’s hospital lien statutes, O.C.G.A. §§ 44-14-470 et seq.  Unfortunately there was only $25,000 in available liability coverage, which was paid into court. In the ensuing dispute over the money, the patient argued that the hospital’s charges were excessive. The amount of the hospital’s lien is expressly limited by statute to “the reasonable charges for hospital . . . care and treatment of an injured person,” O.C.G.A. § 44-14-470(b). The patient sought discovery of pricing agreements between the hospital and insurers such as Blue Cross Blue Shield and concerning the hospital’s indigent care program.  The Medical Center objected and she filed a motion to compel discovery, which the trial court granted subject to the entry of a protective order to ensure confidentiality.

The Georgia Supreme Court, in Bowden v. The Medical Center, 2015 Ga. LEXIS 436 (6/15/15), held that in the dispute over the amount of the hospital lien the “subject matter involved in the pending action” indisputably included whether the amount claimed to be due by the hospital was reasonable, under the terms of the hospital lien statutes, O.C.G.A. §§ 44-14-471(a)(2), 44-14-470(b). Therefore the amounts the hospital charged to other patients for the same type of care were relevant and discoverable, under O.C.G.A. § 9-11-26(b)(1).

“The fair and reasonable value of goods and services is often determined by considering what similar buyers and sellers have paid and received for the same product in the same market, with adjustments upward or downward made to account for pertinent differences, and we see no reason why the same cannot be true of health care.”

And, the Court held that even if the patient had agreed to be responsible for the charges, the contract price for goods and services did not necessarily equal their reasonable value.

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