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Thought this may be of interest. If you find yourself uninsured...check your local hospital for reduced rate or free programs!
By Bruce Japsen
Tribune staff reporter
Published November 2, 2003
Illinois hospitals, long accused of price-gouging the poor and uninsured, have agreed to adopt statewide, income-based discounts and to stop certain aggressive collection practices.
The move toward self-regulation is designed to deflect harsher state and federal rules that could be imposed to quell the public outcry over patients being pulled into court or losing homes, cars and other assets because of unpaid hospital bills.
Because the uninsured do not have the leverage of a large health insurer negotiating their rates, they are left to pay full charges--something akin to a sticker price on a new car. In fact, the uninsured sometimes pay twice as much in Cook County, according to one study.
The large disparity in what patients pay is common in the hospital industry. But as the number of Americans lacking health insurance continues to rise, such practices are attracting more scrutiny from consumer advocates, lawmakers and unions.
While almost all hospitals do offer some form of cash discount for the uninsured, policies about how much of the full bill they must pay and how payments are collected vary widely.
And it is uncommon for patients to be told upfront what kind of discount they may receive or if they qualify for free care, hospitals admit.
To remedy the situation, the Illinois Hospital Association, which represents more than 200 hospitals in the state, agreed last month to establish voluntary guidelines outlining hospital and patient responsibilities. Hospitals are beginning to adopt them or upgrade their existing charity care policies.
"This is very significant," said Joseph Geevarghese, director of the Service Employees International Union's Hospital Accountability Project, which has been pressuring hospitals on the matter. "Patients are usually not notified of the eligibility for charity care or any kind of financial assistance. A lot of the patients we have encountered have faced unreasonable payment demands."
Take Bertha Hardiman, 60, a laundry worker sued three years ago by Bethany Hospital in Chicago because of a $6,200 hospital bill for treatment of gastritis.
She ended up in court despite the fact she had an income of $17,000 a year that could have qualified her for charity care under the hospital's policy at the time.
"It shocked me when [a law-enforcement] officer rang my bell and said I had to go to court," said Hardiman, who said she is still paying off the bill in $200 monthly installments. "It's not easy to pay it. They didn't say they would set up a payment plan for me."
Executives of Bethany and other hospitals say situations like Hardiman's are rare and that they are taking steps to make sure eligible patients do not face similar circumstances.
Hospitals say they are beginning to place signs in emergency rooms and notes in bills stating how to request information about financial assistance.
Hospitals will also not pursue legal action for non-payment of bills against charity care patients who have "clearly demonstrated that they have neither sufficient income nor assets to meet their financial obligations," the association's policy says.
The Illinois Hospital Association said an uninsured patient will receive a 100 percent discount if the patient can demonstrate that his or her income is at or below $8,980 for an individual or $18,400 for a family of four--the federal poverty guideline.
Even uninsured patients who make twice the poverty guideline--$17,960 for an individual or $36,800 for a family of four-- can get a partial discount under the new plan.
"It's the right thing to do," said Ken Robbins, president of the Illinois Hospital Association. "Where there have been examples where automobiles are repossessed or liens have been placed against people's homes, it would appear [that this has happened] in very rare instances."
Earlier this year, giant California-based hospital chain Tenet Healthcare Corp. bowed to pressure from unions and the Latino community and said it would give discounts to uninsured people and stop putting liens on patients' homes.
In Illinois, the pressure has come from a coalition of unions, consumer advocates and influential Democrats, including Illinois Atty. Gen. Lisa Madigan. Madigan two weeks ago opened an inquiry into allegations that billing practices of some hospitals in the state are illegal under the Illinois Consumer Fraud and Deceptive Business Practices Act.
Although it is unclear whether certain hospital billing methods violate state law, the federal government says hospitals must charge the same base rate for everyone. Discounts can then be given through insurers.
Called good first step
Critics of hospital billing practices say the association's decision is a good first step, but that it doesn't have teeth as long as it remains voluntary.
"The hospitals don't have to follow [the association's] guidance," Geevarghese said. "Some hospitals offer uninsured patients automatic non-discretionary discounts based on income. Illinois hospitals say they will consider a low-income person's application for a charity care discount, but it is not guaranteed."
The union's accountability project said patients without health insurance were charged $12,240 per hospital inpatient discharge on average in 2001. Those with insurance, and its negotiated discounts, paid $4,930, according to the study of 49 hospitals in Cook County.
Proposed legislation that would force hospitals to provide charity care or that would regulate how much hospitals can collect has been gaining support in the Democratically controlled Illinois legislature.
But the hospital association believes member facilities will adhere to the guidelines and make an effort to enforce charity care standards.
Northwestern Memorial Hospital in Chicago, for example, said its facility already meets or exceeds the hospital association's guidelines.
"The only issue we probably should and need to look at is the signage issue because we do direct communication to patients, but if there are specifics we need to do regarding signage, certainly we will," said Kelly Sullivan, spokeswoman for Northwestern Memorial.
Advocate Health Care, the Chicago area's largest provider of medical care, in April adopted charity care guidelines that go beyond the hospital association's by offering charity care to those patients who can document income of up to 400 percent of poverty, or $73,600 income for a family of four.
The discounts range from 50 percent to 100 percent for all of Advocate's charity care patients.
"Even before expanding the eligibility criteria, we had an extremely generous charity care program providing financial relief to 98.7 percent of those who apply for this benefit," Advocate spokesman Dan Parker said. "Since Advocate was formed in 1995, we have provided more than $1 billion in charity care and uncompensated care."
Bills written off
Advocate and other hospital operators say most medical bills of the uninsured are written off as bad debt. An increasing amount of bad debt is being written off each year, due in large part to the rising number of uninsured as well as reductions in payments from either government or private managed-care plans.
In Illinois, community hospitals spent nearly $2.1 billion on uncompensated care in 2001. Of that, $1.4 billion was bad debt expense and nearly $700 million was charity care.
"Hospitals on average collect less than 10 percent of uninsured patients' bills," Robbins said.
Charity care has helped millions of Americans, serving as a safety net for the 43.6 million people without health coverage.
When Angela Samuel was laid off from her job as a Citibank branch support supervisor in mid-2000, she could not afford insurance and was unable to pay $10,000 in hospital bills when emergency-room doctors found her to be severely anemic.
She said Advocate Trinity Hospital on the South Side took care of the bill without any hassle once she met with a social worker and submitted tax forms as evidence that she could not afford to pay.
"They told me there was a program available and I would have to pay half or none of the bill," Samuel said. "Once I sent in all the paperwork, I was approved and I didn't have to pay anything. It made me feel very good because it was a big worry because it was such a huge bill."
Copyright © 2003, Chicago Tribune
By Bruce Japsen
Tribune staff reporter
Published November 2, 2003
Illinois hospitals, long accused of price-gouging the poor and uninsured, have agreed to adopt statewide, income-based discounts and to stop certain aggressive collection practices.
The move toward self-regulation is designed to deflect harsher state and federal rules that could be imposed to quell the public outcry over patients being pulled into court or losing homes, cars and other assets because of unpaid hospital bills.
Because the uninsured do not have the leverage of a large health insurer negotiating their rates, they are left to pay full charges--something akin to a sticker price on a new car. In fact, the uninsured sometimes pay twice as much in Cook County, according to one study.
The large disparity in what patients pay is common in the hospital industry. But as the number of Americans lacking health insurance continues to rise, such practices are attracting more scrutiny from consumer advocates, lawmakers and unions.
While almost all hospitals do offer some form of cash discount for the uninsured, policies about how much of the full bill they must pay and how payments are collected vary widely.
And it is uncommon for patients to be told upfront what kind of discount they may receive or if they qualify for free care, hospitals admit.
To remedy the situation, the Illinois Hospital Association, which represents more than 200 hospitals in the state, agreed last month to establish voluntary guidelines outlining hospital and patient responsibilities. Hospitals are beginning to adopt them or upgrade their existing charity care policies.
"This is very significant," said Joseph Geevarghese, director of the Service Employees International Union's Hospital Accountability Project, which has been pressuring hospitals on the matter. "Patients are usually not notified of the eligibility for charity care or any kind of financial assistance. A lot of the patients we have encountered have faced unreasonable payment demands."
Take Bertha Hardiman, 60, a laundry worker sued three years ago by Bethany Hospital in Chicago because of a $6,200 hospital bill for treatment of gastritis.
She ended up in court despite the fact she had an income of $17,000 a year that could have qualified her for charity care under the hospital's policy at the time.
"It shocked me when [a law-enforcement] officer rang my bell and said I had to go to court," said Hardiman, who said she is still paying off the bill in $200 monthly installments. "It's not easy to pay it. They didn't say they would set up a payment plan for me."
Executives of Bethany and other hospitals say situations like Hardiman's are rare and that they are taking steps to make sure eligible patients do not face similar circumstances.
Hospitals say they are beginning to place signs in emergency rooms and notes in bills stating how to request information about financial assistance.
Hospitals will also not pursue legal action for non-payment of bills against charity care patients who have "clearly demonstrated that they have neither sufficient income nor assets to meet their financial obligations," the association's policy says.
The Illinois Hospital Association said an uninsured patient will receive a 100 percent discount if the patient can demonstrate that his or her income is at or below $8,980 for an individual or $18,400 for a family of four--the federal poverty guideline.
Even uninsured patients who make twice the poverty guideline--$17,960 for an individual or $36,800 for a family of four-- can get a partial discount under the new plan.
"It's the right thing to do," said Ken Robbins, president of the Illinois Hospital Association. "Where there have been examples where automobiles are repossessed or liens have been placed against people's homes, it would appear [that this has happened] in very rare instances."
Earlier this year, giant California-based hospital chain Tenet Healthcare Corp. bowed to pressure from unions and the Latino community and said it would give discounts to uninsured people and stop putting liens on patients' homes.
In Illinois, the pressure has come from a coalition of unions, consumer advocates and influential Democrats, including Illinois Atty. Gen. Lisa Madigan. Madigan two weeks ago opened an inquiry into allegations that billing practices of some hospitals in the state are illegal under the Illinois Consumer Fraud and Deceptive Business Practices Act.
Although it is unclear whether certain hospital billing methods violate state law, the federal government says hospitals must charge the same base rate for everyone. Discounts can then be given through insurers.
Called good first step
Critics of hospital billing practices say the association's decision is a good first step, but that it doesn't have teeth as long as it remains voluntary.
"The hospitals don't have to follow [the association's] guidance," Geevarghese said. "Some hospitals offer uninsured patients automatic non-discretionary discounts based on income. Illinois hospitals say they will consider a low-income person's application for a charity care discount, but it is not guaranteed."
The union's accountability project said patients without health insurance were charged $12,240 per hospital inpatient discharge on average in 2001. Those with insurance, and its negotiated discounts, paid $4,930, according to the study of 49 hospitals in Cook County.
Proposed legislation that would force hospitals to provide charity care or that would regulate how much hospitals can collect has been gaining support in the Democratically controlled Illinois legislature.
But the hospital association believes member facilities will adhere to the guidelines and make an effort to enforce charity care standards.
Northwestern Memorial Hospital in Chicago, for example, said its facility already meets or exceeds the hospital association's guidelines.
"The only issue we probably should and need to look at is the signage issue because we do direct communication to patients, but if there are specifics we need to do regarding signage, certainly we will," said Kelly Sullivan, spokeswoman for Northwestern Memorial.
Advocate Health Care, the Chicago area's largest provider of medical care, in April adopted charity care guidelines that go beyond the hospital association's by offering charity care to those patients who can document income of up to 400 percent of poverty, or $73,600 income for a family of four.
The discounts range from 50 percent to 100 percent for all of Advocate's charity care patients.
"Even before expanding the eligibility criteria, we had an extremely generous charity care program providing financial relief to 98.7 percent of those who apply for this benefit," Advocate spokesman Dan Parker said. "Since Advocate was formed in 1995, we have provided more than $1 billion in charity care and uncompensated care."
Bills written off
Advocate and other hospital operators say most medical bills of the uninsured are written off as bad debt. An increasing amount of bad debt is being written off each year, due in large part to the rising number of uninsured as well as reductions in payments from either government or private managed-care plans.
In Illinois, community hospitals spent nearly $2.1 billion on uncompensated care in 2001. Of that, $1.4 billion was bad debt expense and nearly $700 million was charity care.
"Hospitals on average collect less than 10 percent of uninsured patients' bills," Robbins said.
Charity care has helped millions of Americans, serving as a safety net for the 43.6 million people without health coverage.
When Angela Samuel was laid off from her job as a Citibank branch support supervisor in mid-2000, she could not afford insurance and was unable to pay $10,000 in hospital bills when emergency-room doctors found her to be severely anemic.
She said Advocate Trinity Hospital on the South Side took care of the bill without any hassle once she met with a social worker and submitted tax forms as evidence that she could not afford to pay.
"They told me there was a program available and I would have to pay half or none of the bill," Samuel said. "Once I sent in all the paperwork, I was approved and I didn't have to pay anything. It made me feel very good because it was a big worry because it was such a huge bill."
Copyright © 2003, Chicago Tribune
