Advocates, lawmakers push hospitals to help more with bills

AP:

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

Whether you learn about this before those bills wind up in debt collections is another matter.

Medical bills often represent large, unexpected shocks that can crash personal budgets. Roughly one in seven US residents with a credit record has medical debt in collections, according to the non-profit Urban Institute.

Hospitals have ways to keep more people from joining those ranks. Those can include income-based discounts, payment plans, help finding health insurance, or waiving a bill and writing it off as charity care.

But people frequently miss notices in their bills about assistance or have trouble plowing through the paperwork to qualify, patient counsellors say. They say hospitals need to do more to ensure patients know about available help.

“We need a whole new mindset,” said Elisabeth Benjamin, a vice-president with the non-profit Community Service Society of New York. “A hospital’s a charity ... (it) should be figuring out why a patient isn’t able to pay a bill.”

The Affordable Care Act requires non-profit hospitals to tell patients about financial help, but it leaves the details for how that gets done or the extent of the assistance largely up to them. Patient counsellors see little consistency.

Hospitals say they often notify patients several times about available help. They’ve also eased income limits for assistance during the COVID-19 pandemic, and some have smoothed out cumbersome applications.

Assisting people in the middle of a medical crisis can be difficult. Patients often have no idea, when they receive care, what it will ultimately cost and how much help they will need. A slew of insurance notices and bills that arrive later can sow more confusion.

Hospitals frequently post notices about financial help on emergency rooms walls or in bills sent to patients’ homes. But those can be overlooked or forgotten.

Advocates say information about financial assistance should be included on paper that’s a different colour and more noticeable. They also want hospitals to check back in with patients to see if they need help once a bill becomes overdue.

Hospitals often post information about available help online. But that can be hard to find.

Jared Walker, who runs a non-profit called Dollar For that helps people with medical debt, posted a TikTok video in January that shows how to search for financial assistance on hospital websites. It has since been viewed more than 20 million times.

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

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.

SHIFTING THE BURDEN

A new Maryland law requires hospitals to show that they provided information on financial assistance and made a good-faith effort to set up a payment plan before they sue over a medical debt.

That makes the hospital prove it has done all it can to make patient payments affordable, said Marceline White, executive director of the Maryland Consumer Rights Coalition.

“It shifts the burden appropriately to the hospital, the multimillion-dollar entity, as opposed to the person making $40,000,” she said.

No such burdens have shifted in Tennessee, where Debra Smith worries she may be denied future medical care because of her bills.

The Spring Hill resident figures she has more than $10,000 in unpaid medical bills from a string of hospital stays over the past year, even though she has coverage through Medicare. She hasn’t been able to make much progress paying them off.

Smith sought help from Williamson Medical Center in nearby Franklin earlier this year for a $1,500 bill, but they couldn’t settle on a payment plan that fit her budget.

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

She found the hospital’s application for financial help online, but she never completed it. That form asks for copies of bank statements, utility and credit card bills, car payments and other paperwork. To Smith, it felt like they wanted reasons to reject her.

Medical Center spokesman Mike Alday said he couldn’t comment on a specific patient’s situation. But he did say the medical center has to confirm a patient’s financial need before providing help, and the information it requests is standard among hospitals.

Smith figures she can handle about $10 a month, which she said the hospital rejected.

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