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How to Challenge and Defend Against Exorbitant Medical Bills
By Erik P. Crep
Erik P. Crep
Wicker Smith
As we all know, in a personal injury action, a plaintiff is entitled to recover the reasonable value or expense of medical care and treatment necessarily or reasonably obtained by the plaintiff in the past1. So how do you defend against a plaintiff’s medical bills that are clearly unreasonable and inflated? In addition to retaining a billing expert to provide opinions on the reasonableness of plaintiff’s medical bills, this article will explain how to obtain evidence directly from the patient’s medical provider to investigate and challenge the exorbitant sticker price claimed by the plaintiff and plaintiff’s healthcare provider.
In litigation, a plaintiff should not obtain a windfall and a defendant should not be over-exposed to pay excessive damage claims. The plaintiff’s obligation is not to pay whatever the provider demands, but only a reasonable amount.2 While a plaintiff has the burden of proving the reasonable of her medical expenses,3 a plaintiff should not have a monopoly on the evidence at trial with respect to a health care providers’ medical charges. At trial, plaintiffs argue that the charged amount is the reasonable value of the physician, surgery center or hospital’s medical care. However, a jury is not bound by the evidence presented by the plaintiff as to the reasonableness of past medical expenses.4 It is reversible error for the trial court to prohibit the defendant from arguing and proffering evidence that the plaintiff’s medical bills were not reasonable.5
Defendants now have the ability to obtain evidence to present to the jury that the charged amount is not reasonable in the community and not customarily accepted by the particular healthcare provider. Reasonable value is what the physician or surgery center routinely accepts on a regular basis as full payment for exactly the same medical care that the plaintiff in your case received. Actual charges are not instructive on what is reasonable.6
Defendants now have the ability to obtain evidence to present to the jury that the charged amount is not reasonable in the community and not customarily accepted by the particular healthcare provider.
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