First appeared in NY Times
For most of her life, Hope Rubel was a healthy woman with
good medical insurance, an unblemished credit history and a solid career in
graphic design. But on the day an ambulance rushed her to a Manhattan hospital
emergency room shortly after her 48th birthday, she was jobless, uninsured and
having a stroke.
Ms. Rubel’s medical problem was rare, a result of a benign
tumor on her adrenal gland, but the financial consequences were not unusual.
She depleted her savings to pay $17,000 for surgery to remove the tumor, and
then watched, “emotionally paralyzed,” she said, as $88,000 in additional
hospital bills poured in. Eventually the hospital sued her for the money. An Omaha
Hospital Lawyer is interested in these cases.
Yet that year the hospital, NewYork-Presbyterian/Weill
Cornell, had already collected $50.2 million from the state’s so-called
Indigent Care Pool to help care for people like Ms. Rubel who have no insurance
and cannot pay their bills.
New York’s charity care system, partly financed by an 8.95
percent surcharge on hospital bills, is one of the most complicated in the
nation, but many states have wrestled with aggressive debt collection by
hospitals in recent years. Like New York, several passed laws curbing
hospitals’ pursuit of unpaid bills, including Illinois, California and
Minnesota.
But a new study of New York hospitals’ practices and state
records finds that most medical centers are violating the rules without
consequences, even as the state government ignores glaring problems in the
hospitals’ own reports. An Oklahoma
City Hospital Malpractice Lawyer is interested in defending the health care
system in these situations.
“The entire system is corrupted, and it isn’t working for
patients,” said Elisabeth R. Benjamin, vice president of health initiatives at
the Community Service Society of New York, a nonprofit antipoverty group, which
is releasing the two-year study on Monday.
The state’s Department of Health acknowledges systemic
problems, including the need for better reporting and enforcement, a spokesman,
Michael Moran, said. A group of patient advocates and hospital administrators
is being convened to develop a better system, he said, and the department is
engaged in “a comprehensive data integrity project that will include the
retention of an outside auditor.”
The study found that some hospitals did not provide
financial aid applications at all, and that many made impermissible demands for
irrelevant documents or failed to supply key information, like eligibility
rules for big discounts required by state law in 2007. Data reported to the
state was obviously faulty, it found.
Yet even hospitals that reported they had spent nothing on
financial aid, or had filed hundreds of liens against patients’ homes, were
allowed to collect without questions from the charity care pool, which
distributes more than $1 billion a year.
Hospitals are not legally barred from seeking judgments or
liens, but must first offer an aid application, help the patient complete it,
and wait while it is pending. Instead, many hospitals turn to collection
agencies, and sue when that fails. The unpaid bills — typically reflecting much
higher rates than what insurers pay — are then treated as the equivalent of
charity care.
Change is now urgent, health care experts agree, because the
state pool stands to lose hundreds of millions of federal dollars in 2014, when
provisions of the health care overhaul will no longer treat so-called bad debt,
based on uncollected bills, as if it were charity care.
“There’s a law in place, and obviously it should be complied
with,” said David Rich, an executive with the Greater New York Hospital
Association, a trade group. But, he added, “hospitals are providing a lot of
charity care at a loss.”
He said hospitals were improving their compliance with the
law, which requires aid to patients with income up to 300 percent of the
poverty line, or up to $33,000 for a single person. But, often stymied by
patients who fail to complete applications for aid, he said, many hospitals
have moved to simply deeming some patients eligible without an application,
using what he called “a soft credit check” at registration to gauge income and
assets.
Myrna Manners, a spokeswoman for NewYork-Presbyterian
Hospital, said that it would be inappropriate to discuss specific cases, but
that the hospital “proactively helps patients at every step” of the financial
aid process. It approved 25,861 applications in 2010, the most recent annual
data.
“Where there has been a determination that there is an
ability to pay, we still go to all lengths to ensure that we resolve the matter
before it becomes a legal action,” she said.
Court records abound in judgments against patients who say
they had little or no chance to apply for help. A couple fighting foreclosure
in Elmont, Nassau County, has a $41,000 default judgment from NYU Langone
Medical Center for emergency surgery on their disabled adult son in 2007, when
their insurance unexpectedly dropped him. He was eventually approved for
Medicaid, but it would not pay for the surgery retroactively.
The mother, Myrlene Stimphil, 55, a nurse at a city
hospital, said she had sought a reduced payment plan from NYU Langone, but was
told only that the hospital would get back to her. Instead, she said,
collectors were calling her son, now 24, who suffered brain damage at his
premature birth.
“We don’t want to be a burden,” she said, as her husband,
Antenor Francois, 56, a former cabdriver, looked through old bills. One
announced, “Welcome to Portfolio Recovery Associates!” and added that the
collection agency “purchased your account from NYU Hospitals Center.”
Lisa Greiner, a spokeswoman for the hospital, which collected
$10.7 million from the charity care pool in 2010, said she could not comment on
the case under privacy laws. But the hospital no longer uses that collection
agency, and under new leadership in the last three years, its reported
financial aid approvals soared to 36,000 in 2010, from 256 in 2008.
Christopher Ward, 49, living in his father’s house in White
Plains on a $200-a-week disability payment from a workplace spinal injury,
recalled stopping at an A.T.M. — “just to have something in my pocket to buy
food” — and discovering that his accounts, totaling less than $4,000, had been
seized.
“I tore my hair out for a long time not understanding why
all this was happening to me,” Mr. Ward said, admitting to memory lapses.
Court records show that NewYork-Presbyterian obtained a
$102,636 judgment against him in 2007, including 9 percent interest back to
2004, when, uninsured, he underwent emergency surgery for a brain aneurysm. Now
his ailing, widowed father, 75, a teacher at Mercy College, worries that
anything he leaves for Christopher could be seized.
State hospitals seem to be especially aggressive collectors.
State University of New York Downstate Medical Center, in Brooklyn, secures
hundreds of judgments annually through the attorney general’s office, which
says such suits protect the state’s interest in case a former patient comes
into money. A Clarksdale
Hospital Lawyer is watching these cases closely.
One picked at random: a $12,000 judgment in 2008 against
Cherrilyn McFarlane, a single mother on public assistance, for one day’s care
for her newborn five years ago, when her Medicaid coverage had briefly lapsed.
Ms. McFarlane said the judgment could hurt her plans to seek a student loan for
nursing school. “I want to get it cleared,” she said.
To Hope Rubel, the greatest fear was that the suit itself
would deter employers from hiring her and leave her destitute, she wrote the
judge. Finally, she said, a law clerk directed her to the hospital’s financial
aid department. It said more documents were needed to decide her eligibility.
“I had given them everything,” she said. In despair after a
year of courthouse meetings, she said, she offered $100 a month, and at the
court’s urging, the hospital’s lawyers accepted. “I’ll be paying for the rest
of my life,” she said.
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