Hospital Rates

Hospital rates are not set by governmental agencies. In past years, many insurance companies paid the rates charged by hospitals, but only paid prevailing fees to doctors. Consumers generally found that hospital charges (or the percentage of hospital charges the insurance companies had agreed to pay) were fully paid for, but that some doctors charged them fees in excess of the reimbursements.

These hospital rates were often based on the hospital costs plus a certain profit percentage. Inefficient hospitals frequently received higher fees than efficient hospitals. In the past few years, insurance companies have changed their insurance contracts and have begun to pay only prevailing hospital fees. More and more consumers are beginning to discover that they have to pay unexpected charges to hospitals.

Since hospitals are not prohibited from charging more than the prevailing rate, our office cannot assist you in this matter. Since our office can give legal opinions only to certain government officials and not to members of the public, we cannot advise you whether a private lawsuit of a Small Claims Court action would succeed.

If you believe that hospitals should be required to make greater cost disclosures to incoming patients, or that doctors who send patients to hospitals should be required to make greater cost disclosures, you may wish to contact your state or federal legislator and express your view.