Are there any large hospital bills looming over you in your life? This recent article from Axios (How America’s top hospitals hound patients with predatory billing/https://www.axios.com/hospital-billing/ ) caught my eye as it speaks to the reality of how insane hospital medical billing processes can be. It is a real pressure cooker for those caught in the crosshairs.
Managing a Large Hospital Bill
At HealthLink Advocates, we see a lot of these situations. Most often, we get involved when a patient, such as the one covered in the aforementioned article, is hit with a huge hospital bill and becomes panicked when they are unable to immediately pay the bill, or disagrees with the bill. The entire situation can quickly become intimidating, as hospitals have zero personal relationships with patients and can be brutal in their efforts to collect funds due. While most patients are uncomfortable calling out their private physician or any physician on a larger than expected bill, they will usually eventually make those calls to physician’s billing offices to talk about the bill. Often that will lead to some negotiation for a payment plan, correct a billing error or just leave them with a better understanding of how the bill amount was arrived at. Telephone calls to hospitals about a large bill are a different challenge.
A hospital bill can be a big unknown – with very little assistance from the hospital billing service to help you understand what you are looking at. The hospital billing services are big machines themselves – their only purpose is to have the bill paid. Either by the patient or their insurance company. There is no middle. They do not want to hear that you think the bill is too high or incorrect. One needs to understand exactly what the bill entails, what the coding means, and what their own personal contract with the medical insurance is in order to have an effective conversation.
Hospital Files Legal Summon
In the above-referenced Axios article, the patient wound up with a $2,593.43 bill for a visit to the Emergency Room. The billing dilemma was caused as the patient left the ER – without even so much as having had his temperature taken. Assumedly the patient received a bill, felt that they had not received any services, and thus refused to pay the bill. The hospital later filed a summons against the patient to collect on the bill. Also of note is that this billing spread went on for years (February 2018 to June 2020). I can just imagine how those months went. Call after call, threatening letter after threatening letter from the hospital biller, looking to collect the funds. That is a lot of pressure – and all of it stressful!
Hospital billing is also very different from physician billing, as there are systems in place, especially within the Affordable Care Act, which mandates parameters under which hospitals can bill, especially for low and middle-income patients. The regulations target aggressive collection efforts and systems by which patients can apply for financial relief. The trick is for the patient to understand that they have rights.
How Is A Patient To Know?
HealthLink Advocates has had many patients/clients with inordinately high hospital bills that they do not understand, and/or are unable to pay. While it is not an uncommon situation for HealthLink to have to negotiate these balances on behalf of clients, what most patients/clients do not understand is that there are circumstances under which these bills can be reduced. The Affordable Care Act (ACA) mandates apply to everyone – not just those who fall into the category of lower-income. News flash – if you have been out of work, kicked onto COBRA, and are collecting unemployment, you are absolutely covered under the ACA lower-income mandates.
Success Story
One HealthLink Advocate’s patient had, in particular a successful end to this nightmare. The patient had a large bill, over $60,000, for treatment, he had undergone for a particular cancer, which it was suspected that he had contracted while working for a utility company that serviced the downtown New York area after 9-11. He was a member of the crew tasked with repairing the networking and communication infrastructure after the World Trade Center fell. He had been sick for years, eventually diagnosed with cancer. Treatment consisted of several surgical procedures, along with follow-up radiation and chemotherapy. By the time he had contacted HealthLink, he had been out of work for two years, lost his health insurance, and was struggling to not only keep his family afloat but to also pay a little bit of the bill at a time. In this situation, the patient’s financial situation worked in his favor. HealthLink contacted the hospital and applied for a financial relief application with a successful outcome. Not only was the hospital able and willing to reconsider the bill once the financial relief application was submitted, but their in-house policy was such that they were able to extend the financial relief to all bills of the patient’s providers that were contracted through their hospital.
The relief in this case? The entire $60,000 plus amount was forgiven, and all of the physicians treating through the hospital were requested to consider reducing their bills by 50%. Not too professional, but I must say that we were as emotional as the patient while sharing this good news! That hospital? St. Luke's in eastern Pennsylvania. What did it take? A lengthy application, submission of the most recent two years income taxes, and a narrative about the case. The decision was made in four weeks, and the hospital rep reached out after the decision and asked us to make sure to "thank the patient for his service at 9-11". A joyous, human and tearful moment. (Note: This patient was later referred to the “James Zadroga 9/11 Health and Compensation Act” which has been established to aid those suffering from health issues that were traced back to heroic efforts in the aftermath of 9-11).
More Confusion To Know About
Hospital bills are tough because there are a lot of charges, all detailed by CPT codes, which help the professionals identify the services and costs, but are just a jumble to patients. Additionally, there are three (billing) types of common hospitals – Voluntary (nonprofit) Proprietary (for-profit), and Governmental (funded by the Government). All three bill at different mark-ups, all three inflate the bills so that they can maximize what the insurance companies will pay. Horrifying for the patient – who receives the inflated bill, does not understand the costs, and is overwhelmed with the process.
The Axios article is also interesting as it offers some research (as compiled by Johns Hopkins University) that details “charity care ratings” as well as providing information regarding court actions and amounts from each, as well as “average bill markup”. As mentioned in the article, medical debt makes up 58% of all debt collections in the US. As noted in the chart below, many non-profit hospitals mark up their costs as much as 7x the cost of the service. Private, for-profit hospitals can mark up costs as much as 12x. Hospitals defend these outrageous markups by claiming that they are a “tactic” to negotiate with insurance companies. Pity the patient who receives these bills has insurance that will not extend coverage to the bill, and they are paying these large amounts by default. According to the article, the charges are “almost never the actual price paid by insurers, but they can be used for uninsured patients”. In plain language, if you do not have an insurance company backing you up, and you receive one of these inflated bills but do not know how to go about fighting the bill, you – the uninsured pay a higher price. You are caught in the game.
Why is this so shameful? Because…..there are two groups of uninsured:
Group One Uninsured but smart enough to fight the bill and fall into the “low income” category, thus paying a percentage or NONE of the bill.
Group Two Uninsured and taking the bill at face value, paying it off a little bit at a time.
Be sure to reference the article https://www.axios.com/hospital-billing to see what some of the billing quality scores, charity care ratings, total court actions and average bill markups are in your local hospitals.
One day we will hopefully see this game end. Imagine the Group Two patient who tries their best to pay off their bill – only to be paying on an inflated bill that they did not realize that they could fight. A bill that was “marked up” as part of the ruse to obtain more financial compensation from an insurance company.
As for St. Luke's Hospital, the hospital that treated our 9-11 cancer client, it was not part of the database in the Axios article (the article cites the top 100 hospitals in the nation). I wonder how their stats would stand up to those cited above. However, for us here at HealthLink Advocates they are right up there on that scoreboard!
Reference: https://www.axios.com/hospital-billing