Chicago Hospital Sued for Overcharging Uninsured Patient: Illinois Appellate Court Upholds Hospital’s Right to Charge Different Rates

Antonio Galvan, uninsured, sued Northwestern Memorial Hospital once he discovered that he was charged twice as much as an insured patient would have been for the same services. He alleged that the Chicago hospital’s practice of differentiating between uninsured and insured patients constituted unfair and deceptive conduct under the Illinois Consumer Fraud Act.

Plaintiff Galvan was taken to Northwestern Memorial Hospital in Chicago by ambulance after being injured in an automobile accident. Upon his discharge 15 days later he was presented with a hospital bill for $87,033. In his claim against Northwestern he alleged that their practice of billing uninsured patients twice the amount of insured patients was unfair and deceptive.

When measuring unfairness in Galvan, the Illinois Appellate Court considered “(1) whether the practice offends public policy; (2) whether it is immoral, unethical, oppressive or unscrupulous; and (3) whether it causes substantial injury to consumers.”

According to the court, Galvan failed to consider an important fact in his arguments- that there is an obvious difference between an insured and uninsured patient and that it is therefore reasonable to treat them differently. An insured patient pays insurance premiums and in return is awarded a lower service rate. The hospital offers this lower rate because they are guaranteed payment from an insured patient and his/her insurance company. Whereas there is no such guarantee from an uninsured patient.

An insured patient routinely pays for medical expenses in the form of insurance payments and is rewarded with reduced hospital bills. But an uninsured patient doesn’t have the added expense of insurance payments so is hit with a larger bill. The court felt this was a fair practice and that the amount charged by Northwestern did not qualify as “exorbitant”.

The court also held that there was not enough evidence to support Galvan’s deception claim. Galvan alleged that Northwestern concealed from him that it charged uninsured patients twice as much as insured ones.

When considering the deception claim plaintiff must plead (1) a deceptive act or practice by the defendant; (2) an intent by the defendant that the plaintiff rely on the practice; (3) the deceptive practice occurred in the course of conduct involving trade or commerce; and (4) the practice proximately caused the plaintiff’s injury.”

But because Galvan was taken to the hospital in an emergency situation he can’t allege any damages were caused by the concealment of Northwestern’s billing practice. And the emergent nature of his care did not allow any time to talk about billing or fees. So he could not prove that the hospital concealed the information in an intent to mislead him. Therefore the court held that Northwestern’s billing practice was not deceptive.

So while on the surface charging an uninsured patient at least twice as much as an insured patient may seem unfair and deceptive, it does not legally qualify as such.

Kreisman Law Offices practices medical malpractice and personal injury cases for Cook County and its surrounding areas, including Naperville, Inverness, <a href="Naperville“>Evanston, and Tinley Park.