Advocates, lawmakers push hospitals to help more with bills

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But people often overlook clues in their bills of assistance or have trouble digging through paperwork to qualify, patient advisors say. They say hospitals need to do more to ensure that patients are aware of the help that is available.

“We need a whole new way of thinking,” said Elisabeth Benjamin, vice president of the nonprofit Community Service Society of New York. “A hospital is a charity … (it) should figure out why a patient can’t pay a bill.”

The Affordable Care Act requires nonprofit hospitals to provide information to patients about financial aid, but it leaves the details of how this is done or the scope of aid largely to them. Patient advisors see little consistency.

Hospitals say they often tell patients multiple times about available help. They also relaxed the income limits for assistance during the COVID-19 pandemic and smoothed out some awkward requests.

But identifying everyone in need can be difficult, said Rick Gundling, senior vice president of the Healthcare Financial Management Association, which consults with hospitals.

“I think when patients have no money they often withdraw or don’t ask for help when the hospital can help,” said Gundling.

Helping people in a medical crisis can be difficult. Patients often do not know when they will be cared for, what they will ultimately cost and how much help they need. A number of insurance notices and bills that come in later can add even more confusion.

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

Hospitals often post financial aid notices on the walls of the emergency room or in bills to patients’ homes. But these can be overlooked or forgotten.

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

Other proponents say that financial assistance information should be included on paper in a different color and more prominently. They also want hospitals to check back in with patients to see 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 with advocacy group Enlace Chicago.

Most patients, Hernandez said, are never told of available help or even that hospitals have interpreters.

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

Hernandez and Enlace helped a Spanish-speaking janitor pay off nearly $ 100,000 in medical debt that had been collected after his wife’s two strokes last year.

The caretaker, Arturo, is a 43-year-old Mexican immigrant who spoke to The Associated Press on condition not to publish his last name for fear of being deported. He said he tried to speak to one of the hospitals treating his wife about bills. But he never heard of a possible debt settlement until Enlace interfered.

“When you are treated, does it calm you down a little? But when the bills come, where is the help?” he asked.

Hospitals often post information about available help on the Internet. But that can be hard to find.

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

“Hospitals don’t rooftop shouting that you can apply for charity, that’s damn safe,” said Walker.

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

Oregon Health & Science University reduced their application for assistance a few years ago.

Now, when someone calls for help paying for emergency or medically necessary care, all the Portland Academic Health Center asks for is patient income, which it does a gentle credit check. This approach replaced a paper application that required multiple documents.

“We are here to take care of the people. We’re not here to take care of people’s medical bills, ”said Kristi Cushman, director of patient access services for the center.

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

A new law in Maryland requires hospitals to demonstrate that they have provided financial assistance information and have made good faith efforts to establish a payment schedule before filing a medical debt suit.

In doing so, the hospital is proving that it has done everything in its power to make patient payments affordable, said Marceline White, executive director of the Maryland Consumer Rights Coalition.

“It appropriately puts the burden on the hospital, the multimillion-dollar unit as opposed to the person who makes $ 40,000,” she said.

Such burdens have not shifted in Tennessee, where Debra Smith fears that her bills may deny her future medical care.

The Spring Hill resident believes she has more than $ 10,000 in unpaid medical bills from a series of hospital stays last year despite being covered by Medicare. She wasn’t able to make any great strides to pay them off.

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

Health problems prevent Smith from working. Living expenses and prescriptions use up most of the $ 2,300 per month the 57-year-old receives from a pension and social security.

She found the hospital’s application for financial aid on the Internet, but never filled it out. This form requires copies of bank statements, utility bills and credit cards, car payments, and other papers. For Smith, it felt like they wanted reasons to refuse her.

Medical center spokesman Mike Alday said he was unable to comment on a particular patient’s situation. However, he said the medical center must confirm a patient’s financial need before they can provide assistance, and the information requested is standard in hospitals.

Alday said the medical center is providing financial advisors and offering discounts and payment plans when patients fail to complete applications for financial assistance. It would give someone with an outstanding balance of $ 1,500 18 months to pay it off. That equates to monthly payments of around $ 83.

Smith believes she can process about $ 10 a month, which she says the hospital has turned down.

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


Associate press writer Suman Naishadham contributed to this story.


The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.