We’ve also seen hospitals charge obscene amounts for standard procedures— $5,600 for a CT scan, $46,000 for an arthroscopic knee, etc. In litigation the hospitals’ position has been revealed: since the Utilization Review rules indicate such a low per diem rate for inpatient stays, they believe that they are entitled to “gouge”— yes, that is the exact word that was used–the carriers on the outpatient services, since the specific UR rule regarding outpatient services does not explicitly require the charges to be “reasonable.”
We audit workers comp payments for several hospitals in Louisiana, and have not seen significant evidence of “price gouging”. However, we have seen carriers reducing the charges to their own determination of UCR rather than the typical 90%-of-charges mandated in the rules. On inpatient claims, in comparison to other Southern states, outliers and high dollar claims are extremely difficult to get paid when attempting to argue for “special consideration” as again mandated in the rules. Maybe the scale is tipped in favor of the hosptials for outpatient claims, but their true loss is on inpatient claims.
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We’ve also seen hospitals charge obscene amounts for standard procedures— $5,600 for a CT scan, $46,000 for an arthroscopic knee, etc. In litigation the hospitals’ position has been revealed: since the Utilization Review rules indicate such a low per diem rate for inpatient stays, they believe that they are entitled to “gouge”— yes, that is the exact word that was used–the carriers on the outpatient services, since the specific UR rule regarding outpatient services does not explicitly require the charges to be “reasonable.”
We audit workers comp payments for several hospitals in Louisiana, and have not seen significant evidence of “price gouging”. However, we have seen carriers reducing the charges to their own determination of UCR rather than the typical 90%-of-charges mandated in the rules. On inpatient claims, in comparison to other Southern states, outliers and high dollar claims are extremely difficult to get paid when attempting to argue for “special consideration” as again mandated in the rules. Maybe the scale is tipped in favor of the hosptials for outpatient claims, but their true loss is on inpatient claims.