Establishing the Reasonable Cost of Medical Bills – Still No Good Answer

One issue we see come up deals with the reasonable cost of medical bills for those who are uninsured.

Bermudez v Ciolek, 237 Cal.App.4th 1311 (2015) does a good job of identifying the challenges in establishing the reasonableness of medical bills when the medical bills have not been paid. The bills themselves will not meet the burden of establishing reasonableness and there is a question as to whether these bills are admissible even when the plaintiff recognizes responsibility to pay the bills.

Although the best support for the medical bills would be medical experts, the Court points out that appropriate objection may preclude this testimony if the medical experts were not able to link their opinion to a “market or exchange value” of medical services. This is a challenging burden since the medical profession has established numerous markets based upon the identity of the payer or potential payer. In other words, the same medical service has a different value if the payer is Medicare, Medicaid, Blue Cross or an uninsured.

If the unpaid medical bills are not relevant how can the market value of services rendered to an uninsured be established unless the bills have been paid? People that are uninsured can not afford to pay the exorbitant billings they encounter.  Bermudez does not offer solutions to the issues it identifies. Hopefully more guidance is on the way.

Perhaps the ultimate solution requires the standardization of billing practices.