[bshep]

I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay.

I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document?

Edit: Or imagine a disgruntled employee in the copy room changing the form?

[b3morales]

The hospital would most likely have a very easy argument that since it's not actually their standard form and you didn't tell them about it, they didn't accept the agreement in any way. And they'd probably try to get you for fraud as well.

See also https://xkcd.com/1494/

[nrmitchi]

So I guess the standard "you should have read the terms and conditions before you signed the form" only applies in one direction eh?

[ajross]

If you present a contract to the hospital and explain that these are your terms, and a reasonably understood officer of the business signs it, then sure: they're on the hook. Contracts are contracts, and the law gives great weight to consent, even in circumstances like this where it's not clear a real negotiation happened.

The idea above was about "swapping" some random document in for the standard form and presenting it to them as if it was their document. That's not good faith negotiation, that's just fraud.

[drdec]

You don't need the new document to hold up in court, the gambit is to deprive them of having your legal agreement.

Granted, a court might still see that as fraud, IANAL.

[ajross]

And again, refusing to sign a contract while presenting to a business as if you did for the purpose of getting out of the payment agreement is simply fraud. It's not even arguable.

[rowanG077]

If you gave back a different form and the hospital doesn't bother to check it's their fault. Sending back amended contracts back to back during negotiations is completely normal.

[resoluteteeth]

There is a difference between informing them you are modifying it or sending back a clearly edited version and stealthily modifying it in the hopes that they won't notice.

I don't think it's going to hold up if you surreptitiously modify it in bad faith.

[kadoban]

Negotiating the terms of contracts isn't fraud. Neither is refusing their insane terms, no matter how "standard" they want you to believe they are.

[brazzy]

Swapping forms in secret is the opposite of negotiating.

[kadoban]

That's true. But then again, "sign this or you're dead" isn't negotiating either.

The most honest behavior would probably be to mark additions or changes on the form they give you, if they'll fit.

[ClumsyPilot]

What do you mean in secret? The person explicitly talks about providing the hospital with alternative agreement. It is their responsebility to read everything they sign, just like it is the patient's

[brazzy]

The comment I was referring to: https://news.ycombinator.com/item?id=31461781

Verbatim quote: "I doubt anyone would catch it".

That is not negotiating, that is fraud.

It is absolutely not your responsibility to check for the case that you give someone papers to sign and they give you back something different unless they tell you so.

[jtc331]

It’s not secret. This is standard contract negotiation (sending along a new draft).

[paisawalla]

Correct. Sending a new draft along with a message saying "here are our revisions," is standard contract negotiation. You would have no case that the new terms were consented to.

It's amazing that you people are still arguing this in earnest so far down the thread. Can you think for a second what the implications of this would mean for society, if it were an acceptable form of "negotiation"? It would be even worse for the ordinary little people.

[brazzy]

If you explicitly tell the other side that there are changes, sure.

But the comment I was referring to talked about "swapping" the papers and said "I doubt anyone would catch it". That does not sound like negotiating in good faith to me.

https://news.ycombinator.com/item?id=31461781

[Peku]

There is a story is someone doing something similar with their credit card [1].

Not sure how well something like this would fly in the states, but it would be interesting.

[1] https://www.nasdaq.com/articles/updated-russian-man-turns-ta...

[TheOtherHobbes]

IANAL, but I suspect it's deceptive if the changes were deliberately hidden and there is no notification of them.

For example - if someone agreed a contract, changes are made, and they were pressured to sign without reading the document.

If changes are flagged and/or highlighted it would stand a reasonable chance of being valid. Likewise if the patient sent a cover email/letter saying "This is my standard contract."

Because these exchanges are bureaucratic, it's quite likely the changes wouldn't be noted - or might possibly be automated.

It could be argued that's a failure of diligence by the hospital rather than fraud.

And it's also clearly unconscionable to expect patients to sign a literal blank check with an open amount without anything resembling a credible estimate. That's simply unenforceable.

All of this underlines why single-payer is the only viable system. Without it a few people get extremely rich with huge financial and social costs to everyone else - which is not freedom, it's forced tribute and subsidy.

[Vecr]

It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.

[bshep]

In my experience these forms are only signed by patients, so why are they valid in those cases?

[lisper]

The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.

[DennisP]

Well if the patient swapped the form, it would be pretty clear they didn't actually agree to the terms of the original form.

[cperciva]

And if they swap the form in secret in order to trick surgeons into performing an operation which they haven't agreed to pay for, it's pretty clear that they're committing fraud.

[mindslight]

Fraud is a strong claim, and it's not clear that there is even an implied contract formed - a contract requires defined consideration. An arbitrary amount conjured out of a hat after service is not well-defined consideration.

From my understanding, the medical billing system is so fucked precisely because hospitals bought laws making it so they can arbitrarily bill patients without forming a proper contract (otherwise there would be no way to charge someone who was admitted while unconscious). In the absence of such laws they'd have to fall back to an unjust enrichment claim, under which it would be pretty hard to justify charging someone $25 for an aspirin.

[jtc331]

People keep saying “in secret” but that’d only be true if it happened after it were filed or some such. Giving someone an amended contract isn’t fraud.

[rowanG077]

What do you mean "in secret"? The hospital received the form in full detail. There is nothing secret about it. It's like claiming the ToS are secret because none reads it.

[criddell]

When I was registering as a new patient at a dentist, they gave me the standard form that would let them do things like contact my employer if I didn’t pay my bill on time. I stroked a bunch of that stuff out and initialed it.

If it ended up in court and they produced that form, would my amendments mean anything? Is it a contract when only one part signs it?

[ipython]

Can’t do that at our local hospitals. The forms are all computerized and your signature is captured on a small tablet.

[est31]

What protects you from them swapping the forms then? All you gave them was a picture of your signature, they could add it to any form they'd want.

[missedthecue]

There really isn't anything anyone can preemptively do about someone else committing outright fraud. If that's their intent, all they need to do is photocopy a paper form with your signature on it, and move your signature anywhere they want.

[ipython]

Nothing, obviously. But I didn’t think this was a contest to see who could defraud the customer. Clearly we already established they can charge whatever they like, what more do you want? :)

[Chris2048]

IF they sign first there's no way to do the switch: the new form would be either missing their signature, or be an (illegal) modification if original terms.