Lawyers, lawmakers push hospitals to help more with bills



Debra Smith, 57, sorts her medical bills in her living room on Thursday, October 7, 2021 in Spring Hill, Tennessee.  Smith, who has health problems that prevent him from working, has about $ 10,000 in unpaid medical bills.  Patient advocates and some state governments say hospitals need to do more to help patients cope with medical bills before debt ends up in collection.  (AP Photo / Mark Zaleski)

Debra Smith, 57, sorts her medical bills in her living room on Thursday, October 7, 2021 in Spring Hill, Tennessee. Smith, who has health problems that prevent him from working, has about $ 10,000 in unpaid medical bills. Patient advocates and some state governments say hospitals need to do more to help patients cope with medical bills before debt ends up in collection. (AP Photo / Mark Zaleski)


Inundated with medical bills? The hospital that treated you may be able to help.

Whether you find out before those bills end up in debt collection is another matter.

Medical bills are often big and unexpected shocks that can crush personal budgets. According to the nonprofit Urban Institute, about 1 in 7 U.S. residents with a credit history has medical debt in collection.

Hospitals have ways of preventing more people from joining these ranks. These can include income-based discounts, payment plans, help finding health insurance, or canceling a bill and writing it off as charity care.

But people often lack notice in their bills about assistance or struggle to navigate the paperwork to qualify, patient advisers say. They say hospitals need to do more to make sure patients know what help is available.

“We need a whole new mindset,” said Elisabeth Benjamin, vice president of the nonprofit Community Service Society of New York City. “A hospital is a charity… (it) should determine why a patient is not able to pay a bill.”

The Affordable Care Act requires nonprofit hospitals to tell patients about financial aid, but it largely leaves the details of how it is done or the extent of the aid up to them. Patient advisers see little consistency.

Hospitals say they often repeatedly inform patients about available help. They have also relaxed income limits for assistance during the COVID-19 pandemic, and some have smoothed out cumbersome requests.

But it can be difficult to identify everyone who needs help, said Rick Gundling, senior vice president of the Healthcare Financial Management Association, which consults with hospitals.

“I think a lot of times when the patient doesn’t have the money they just pull out or don’t ask for help, when the hospital can help,” Gundling said.

Helping people in the midst of a medical crisis can be difficult. Patients often have no idea when to receive care, what it will cost them in the end, and what help they will need. A multitude of insurance notices and bills that arrive later can be confusing.

Benjamin said she once helped a patient who had a kidney stone removed and received 28 bills.

Hospitals frequently post financial aid notices on emergency room walls or on bills sent to patients’ homes. But these can be overlooked or forgotten.

“People never read the entire bill. They are scary and overwhelming, ”said Benjamin, who would like hospitals to include a one-page financial aid form with their bills.

Other advocates say financial aid information should be included on paper in a different color and more prominent. They also want hospitals to check with patients if they need help once a bill is overdue.

Communication is often the biggest barrier low-income patients face when dealing with hospitals, according to Ilda Hernandez, community health worker at advocacy group Enlace Chicago.

Most patients, Hernandez said, are never made aware of the assistance available or even that hospitals have interpreters.

“They are not told they can ask for a social worker in a hospital,” she said, “and so patients don’t ask.”

Hernandez and Enlace helped a Spanish-speaking janitor settle nearly $ 100,000 in medical debts that were collected after his wife suffered two strokes last year.

The janitor, Arturo, is a 43-year-old Mexican immigrant who spoke to The Associated Press on the condition that he not publish his last name because he fears deportation. He said he tried to talk about bills with one of the hospitals treating his wife. But he never heard of a possible debt resolution until Enlace got involved.

“When you’re treated, it calms you down a bit… but once the bills come in, where’s the help?” He asked.

Hospitals often publish information about the help available online. But it can be hard to find.

Jared Walker, who runs a nonprofit called Dollar For that helps people with medical debt, posted a TikTok video in January that shows how to seek financial help on hospital websites. It has since been viewed over 20 million times.

“Hospitals aren’t screaming from the rooftops that you can ask for charitable care, that’s for sure,” Walker said.

Some hospitals – and state lawmakers – are trying to make improvements.

Oregon Health & Science University curtailed its request for help a few years ago.

When someone asks for help paying for emergency or medically necessary care, Portland University Health Center now simply asks for the patient’s income, which they check with a smooth credit check. This approach replaced a paper application that required multiple documents.

“We’re here to take care of people. We’re not here to make people worry about their medical bills, ”said Kristi Cushman, director of patient access services at the center.

Several states have laws that require hospitals to offer a range of free or discounted care, usually based on income, according to the National Consumer Law Center.

A new Maryland law requires hospitals to show that they have provided financial aid information and made a good faith effort to set up a payment plan before suing for medical debt.

This allows the hospital to prove that it has done everything it can to make patient payments affordable, said Marceline White, executive director of the Maryland Consumer Rights Coalition.

“This shifts the burden appropriately to the hospital, the multi-million dollar entity, as opposed to the person earning $ 40,000,” she said.

None of those burdens have changed in Tennessee, where Debra Smith fears she will be denied future medical care because of her bills.

The Spring Hill resident estimates that she has over $ 10,000 in unpaid medical bills from a series of hospital stays over the past year, even though she is covered by Medicare. She couldn’t make much progress in paying them.

Smith enlisted help from Williamson Medical Center in nearby Franklin earlier this year with a bill for $ 1,500, but they couldn’t agree on a payment plan to fit his budget.

Health problems prevent Smith from working. Living expenses and prescriptions consume most of the $ 2,300 a month the 57-year-old receives from pension and Social Security.

She found the hospital’s financial aid application online, but never filled it out. This form requests copies of bank statements, utility and credit card bills, car payments, and other documents. For Smith, it was as if they wanted reasons to reject her.

Medical center spokesperson Mike Alday said he could not comment on a specific patient’s situation. But he said the medical center must confirm a patient’s financial needs before providing help, and the information it requests is standard among hospitals.

Alday said the medical center makes financial advisers available and offers discounts and payment plans if patients fail to complete applications for financial assistance. This would give someone with an outstanding balance of $ 1,500 18 months to pay it off. This equates to monthly payments of around $ 83.

Smith estimates she can handle around $ 10 a month, which the hospital has rejected.

“I know hospitals need their money, but… I need it too,” she said. “I don’t want anything free, but under the circumstances a little understanding would be nice.”


Associated Press writer Suman Naishadham contributed to this story.


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