Court Opinion

ID: 9836195
Source: CourtListenerOpinion
Date Created: 2023-09-02 03:01:54.826541+00
Date Added: 2024-06-11T07:45:14.313841
License: Public Domain

KAUGER, J.,
concurring specially:
¶ 11 agree with the majority that Petitioner has failed to demonstrate the unconstitutionality of 12 O.S. 2011 § 3009.1, and write separately to highlight the policy reasoning behind by the statute. Title 12 O.S. 2011 § 3009.1 limits the admissibility of evidence regarding medical costs to that which has been paid or is owed, rather than that which has been billed.1
¶ 2 The statute is necessary because of the opaque process of medical services pricing, in which there is often a significant difference between the price that is billed and the price that is paid.2 The amount billed for a medical service is not the amount a provider expects to collect. Instead, it is a starting position for negotiations with private insurers, Medicare, Medicaid, and other groups.3 If a physician or hospital initially bills at an inflated rate, they are more likely to ultimately receive a higher amount. There are thus structural incentives for a service provider to bill at an exaggerated rate, and this occurs nationwide. In 2004, hospitals in the United States received only thirty-eight percent of the initially listed price.4 The pricing in the present case is similar. The initial bill was for *754$8,112.81, while only $2,845.11 was actually paid.
¶ 3 This process is inefficient and leads to uncertainty. In hospitals, a patient will often sign a “Statement- of Financial Responsibility5’ instead of agreeing to a specific and set price.6 A patient is consequently purchasing a service without knowing how much that service will cost. Then; they will be billed at a specific and set price that will later be discounted as a result of negotiations-.between the provider and insurer. Throughout this process, the patient remains unsure what is actually owed. The solution seems clear: medical service providers should stop inflating prices on the initial bill. Like every other commercial transaction, the amount that is billed and the amount that is owed should be the same.
¶ 4 However, those are not the present circumstances. Title 12 O.S. 2011 § 3009.16 is a reaction to the way that medical services are priced. It ensures that a plaintiff does not receive a windfall; but also ensure that'-the measure of damages “is the amount which will compensate for all detriment.”7

.Tide 12 O.S. 2011 § 3009.1 provides:
A. Upon the trial of any civil case involving personal injury, the actual amounts paid for any doctor bills, hospital bills, ambulance service bills, drug bills and similar bills for expenses incurred in the treatment of the party shall be the amounts admissible at trial, not the amounts billed for expenses incurred in the treatment of the party. If, in addition to evidence of payment, a signed statement acknowledged by the medical provider or an authorized representative that the provider in consideration of the patient's efforts to collect the funds to pay the provider, will accept the amount paid as full payment of the obligations is also admitted. The statement shall be part of the record as an exhibit but need not be shown to the jury. Provided, if a medical provider has filed a lien in the case for an amount in excess of the amount paid, then bills in excess of the amount paid but not more than the amount of the lien shall be admissible. If no payment has been made, the Medicare reimbursement rates in effect when the personal injury occurred shall be admissible if, in addition to evidence of nonpayment, a signed statement acknowledged by the medical provider or an authorized representative that the provider, in consideration of the patient's efforts to collect the funds to pay the provider, will accept payment at the Medicare reimbursement rate less cost of recovery as provided in Medicare regulations as full payment of the obligation is also admitted. The statement shall be part of the record as an exhibit but need not be shown to the jury. Provided, if a medical provider has filed a lien in the case for an amount in excess of the Medicare rate, then bills in excess of the amount of the Medicare rate but not more than the amount of the lien shall be admissible.
B. This section shall apply to civil cases involving personal injury filed on or after November 1, 2011.

. George A. Nation III, Determining the Fair and Reasonable Value of Medical Services: The Affordable Care Act, Government Insurers, Private Insurers and Uninsured Patients, 65 Baylor L. Rev. 425, 432 (2013).

. Keith T. Peters, What Have We Here? The Need for Transparent Pricing and Quality Information in Health Care: Creation of an Sec for Health Care, 10 J. Health Care L. & Pol’y 363, 366 (2007).

. Peters, supra note 3 (citing Uwe E., Reinhardt, The Pricing of U.S. Hospital Services: Chaos Behind a Veil of Secrecy, 25 Health Aff. 57, 57 (2006)).

. Nation, supra note 2 at 426.

. See note 1, supra.

. Title 23 O.S. 2011 § 61 provides that:
For the breach of an obligation not arising from contract, the measure of damages, except where otherwise expressly provided by this chapter, is the amount which will compensate for all detriment proximately caused thereby, whether it could have been anticipated or not.