Texas Supreme Court Building

First came the crash. Then came the bill.

After a June 2015 car accident landed Crystal Roberts in the emergency room at North Cypress Medical Center, the hospital asked for more than $11,000 for the X-rays, CT scans, lab tests and other services she received. To Roberts, who was uninsured, that was quite a tab. She sued, calling the price excessive โ€”ย it was more, she and her lawyers alleged, than an insurance company would have paid for the same procedures. Under the Texas hospital liens statute, hospitals have to charge uninsured patients a โ€œreasonable and regular rate.โ€

To prove the charge was excessive, Roberts asked the medical center for more information: If she had been insured by, say, Aetna, Blue Cross Blue Shield or Medicare, how much would her insurance company have paid the hospital?

North Cypress wouldnโ€™t provide that information, arguing that it was irrelevant to the lawsuit and that the organization would โ€œsuffer irreparable harmโ€ if it disclosed โ€œconfidential and proprietaryโ€ insurance information.

This year, the issue made it to the stateโ€™s highest civil court, and on Friday, the Texas Supreme Court ruled in a 6-3 decision that the information should be given to Roberts because it’s relevant to her case. The decision, authored by Justice Debra Lehrmann, is likely to make it easier for uninsured Texans to negotiate high hospital bills under similar circumstances.

In cases like Robertsโ€™, hospitals arenโ€™t allowed to charge uninsured patients more than a โ€œreasonable and regular rateโ€ โ€”ย essentially, Robertsโ€™ lawyer James Amaro said, what an insurance company would pay for the same services. But until Friday, uninsured patients trying to challenge excessive hospital bills werenโ€™t able to see what insurance companies paid for similar services. The ruling, Amaro said, will allow light to shine on a notoriously mysterious process and make it easier for patients to negotiate fair payments in the future.

โ€œNo mechanism has existed to challenge excessive hospital bills for uninsured accident victims,โ€ Amaro said. โ€œThis will reduce the price-gouging schemes that are just rampant right now.โ€

Lawyers for North Cypress Medical Center did not return requests for comment Friday. But Chad Ruback, one of the hospitalsโ€™ lawyers, told Law360 last year that if Roberts won, it โ€œwould, sadly, increase costs for all hospital patients.โ€

โ€œIโ€™m afraid that this type of discovery tactic will routinely be used to strong-arm settlements of otherwise meritless claims against hospitals,โ€ Ruback said in May 2017.

Lehrmann wrote in her opinion that hospitals concerned about private information being made public could ask the trial court to seal that information, meaning those documents would aid Roberts and patients like her but wouldnโ€™t be made available to the broader public. That decision would be made in the future by the trial court.

Disclosure: Blue Cross Blue Shield of Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of themย here.ย 

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Emma Platoff was a reporter at the Tribune from 2017 to 2021, most recently covering the law and its intersection with politics. A graduate of Yale University, Emma is the former managing editor of the...