An uninsured patient has sued St. Peter's Hospital in Helena, Mont., over discounts it provides to health insurers. Jessica Gazelka claims such "preferred provider agreements" illegally fix prices and discriminate against patients who lack health insurance, reports the Independent Record.
After a visit to St. Peter's emergency room, uninsured Gazelka was billed $2,121.43. However, the bill would have dropped 20-25 percent had she been covered by Blue Cross Blue Shield of Montana, according to the suit.
St. Peter's is the dominant provider in Helena, and Blue Cross controls 60 percent of the individual health insurance market and 55 percent of the group insurance market across the state, notes the Independent Record. The lawsuit claims that with such market dominance, the arrangement between St. Peter's and Blue Cross prevents cost control and competition.
"St. Peter's follows normal business practices associated with discounts," hospital spokeswoman Peggy Stebbins said in an email to the Independent Record. "This appears to be a broader health care policy argument facing the entire country."
And as the industry explores accountable care organizations (ACO) to improve quality and lower costs, such provider-payer arrangements are often an arguing point in the debate over accountable care. But according to to Gail Kursh, deputy chief of the legal policy section of the antitrust division of the Department of Justice, most ACOs won't violate antitrust laws.
"[The antitrust agencies] recognize that ACOs do have potential to improve care, but it's essential that ACOs don't eliminate competition that will raise prices or reduce choices for patients," she said.
According to the patient's attorney, if the case is successful and establishes legal precedent, other hospitals in Montana could face similar suits, notes the Independent Record.
For more information:
- read the Independent Record article
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