Medical Billing
& Fair Market Value
Overview
There is a tradition in the U.S. medical care industry of health care providers submitting bills and charges for services rendered but routinely accepting much less than those amounts in full satisfaction of those charges. This implies that the reasonable value, relative market value, or fair market value of medical services is different than charged or billed amounts. We apply health economics methodology to determine the reasonable and fair market value of medical care charges and billed amounts. This work is featured in our life sciences consulting work and our litigation work.
Types Of Engagements
- Calculation of reasonable value of medical bills in personal injury cases
- Calculation of Medicare, Medicaid, workers’ compensation, and Personal Injury Protection (PIP) payments
- Cost parameter estimates in cost impact, budget impact, and cost-effectiveness models
- Mapping cost data to clinical trial data in U.S. and globally
Reasonable Value of Medical Charges
Key Staff
- John Schneider, PhD
- Cara Scheibling, MBA
- Anna Whelan, BA
- Anthony LoSasso, PhD
- Robert Ohsfeldt, PhD
Related Markets & Industries
- Insurance & third-party payers
- Attorneys & law firms
- Medical services
- Utilities
- Construction
- Transportation
Related Publications
Related Issue Briefs
- What are “Hedonic Damages,” and Should They Matter in Litigation? (Issue Brief No. 56)
- The Rise of Litigation Funding and Medical Funding in Personal Injury and Product Liability Lawsuits (Issue Brief No. 54)
- Electronic Medical Records: Potential Issues in Litigation and Biomedical Research (Issue Brief No. 48)
- What is the Reasonable Value of Future Medical Care? (Issue Brief No. 44)
- U.S. Health Care Costs: Disentangling Underlying Trends from the Effects of the Affordable Care Act (Issue Brief No. 8)
- Nobody Pays Retail: A Primer on Valuing Medical Care Bills (Issue Brief No. 2)
- Using Publicly Available Health Care Databases to Value & Price Medical Care Services (AHE Issue Brief No. 1)