Archive for September, 2020

Heartbreaking Bills, Lawsuit and Bankruptcy — Even With Insurance Kaiser Health News


Matthew Fentress was just 25 when he passed out while stuffing cannolis as a cook for a senior living community six years ago. Doctors diagnosed him with viral cardiomyopathy, heart disease that developed after a bout of the flu.

Three years later, the Kentucky man’s condition had worsened, and doctors placed him in a medically induced coma and inserted a pacemaker and defibrillator. Despite having insurance, he couldn’t pay what he owed the hospital. So Baptist Health Louisville sued him and he wound up declaring bankruptcy in his 20s.

“The curse of being sick in America is a lifetime of debt, which means you live a less-than-opportune life,” said Fentress, who still works for the senior facility, providing an essential service throughout the coronavirus pandemic. “The biggest crime you can commit in America is being sick.”

Financial fears reignited this year when his cardiologist suggested he undergo an ablation procedure to restore a normal heart rhythm. He said hospital officials assured him he wouldn’t be on the hook for more than $7,000, a huge stretch on his $30,000 annual salary. But if the procedure could curb the frequent extra heartbeats that filled him with anxiety, he figured the price was worth it.

He had the outpatient procedure in late January and it went well.

Afterward, “I didn’t have the fear I’m gonna drop dead every minute,” he said. “I felt a lot better.”

Then the bill came.

Patient: Matthew Fentress is a 31-year-old cook at Atria Senior Living who lives in Taylor Mill, Kentucky. Through his job, he has UnitedHealthcare insurance with an out-of-pocket maximum of $7,900 — close to the maximum allowed by law.

Total Bill: Fentress owed a balance of $10,092.13 for cardiology, echocardiography and family medicine visits on various dates in 2019 and 2020. UnitedHealthcare had paid $28,920.52 total, including $27,561.37 for the care he received on the day of his procedure.

Service Provider: Baptist Health Louisville, part of the nonprofit system Baptist Health.

Medical Service: Fentress underwent cardiac ablation this year on Jan. 23. The outpatient procedure involved inserting catheters into an artery in his groin that were threaded into his heart. He also had related cardiology services, testing and visits to a primary care doctor and a cardiologist before and after the procedure.

What Gives: Fentress said he always made sure to take jobs with health insurance, “so I thought I’d be all right.”

But like nearly half of privately insured Americans under age 65, he has a high-deductible health plan, a type of insurance that experts say often leaves patients in the lurch. When he uses health providers within his insurer’s network, his annual deductible is $1,500 plus coinsurance. His out-of-pocket maximum is $7,900, more than a quarter of his annual salary.

Fentress owed around $5,000 after his 2017 hospitalization and set up a monthly payment plan but said he was sent to collections after missing a $150 payment. He declared bankruptcy after the same hospital sued him.

He faced another bill about a year later, when a panic attack sent him to the emergency room, he said. That time, he received financial aid from the hospital.

When he got the bill for his ablation this spring, he figured he wouldn’t qualify for financial aid a second time. So instead of applying, he tried to set up a payment plan. But hospital representatives said he’d have to pay $500 a month, he said, which was far beyond his means and made him fear another spiral into bankruptcy.

This precarious situation makes him “functionally uninsured,” said author Dave Chase, who defines this as having an insurance deductible greater than your savings. “It’s a lot more frequent than a lot of people realize,” said Chase, founder of Health Rosetta, a firm that advises large employers on health costs. “We’re the undisputed leaders in medical bankruptcy. It’s a sad state of affairs.”

Jennifer Schultz, an economics professor and co-director of the Health Care Management program at the University of Minnesota-Duluth, said Fentress faces a difficult financial road ahead. “Once you declare bankruptcy, your credit rating is destroyed,” she said. “It will be hard for a young person to come back from that.”

recent survey by the Commonwealth Fund found that just over a quarter of adults 19 to 64 who reported medical bill problems or debt were unable to pay for basic necessities like rent or food sometime in the past two years. Three percent had declared bankruptcy. In the first half of 2020, the survey found, 43% of U.S. adults ages 19 to 64 were inadequately insured. About half of them were underinsured, with deductibles accounting for 5% or more of their household income, or out-of-pocket health costs, excluding premiums, claiming 10% or more of household income over the past year.

In Fentress’ case, the $10,092 he owed the hospital was more than a third of what his insurer paid for his care. The majority of his debt — $8,271.56 — was coinsurance, about 20% of the bill, which he must pay after meeting his deductible. Because the bill covered services spanning two years, he owed more than his annual out-of-pocket maximum. If all his care had been provided during 2019, he would have owed much less and the insurer would have been responsible for more of the bill.

Dr. Kunal Gurav, an Atlanta cardiologist who wrote about medical costs for the American College of Cardiology, said ablation usually costs about $25,000-$30,000, a range also confirmed by other experts.

The insurer’s payment for Fentress’ care that January day — around $27,600 — falls into the typical cost range, Gurav said. Fentress is being asked to pay $9,296, meaning the hospital would get more than $36,000 for the care.

Schultz, a state representative from Minnesota’s Democratic-Farmer-Labor Party, said nonprofit hospitals could potentially waive or reduce costs for needy patients.

“They definitely have a moral responsibility to provide a community benefit,” she said.

Resolution: Charles Colvin, Baptist Health’s vice president for revenue strategy, said hospital officials quoted Fentress an estimated price for the ablation that was within a few dollars of the final amount, although his bill included other services such as tests and office visits on various dates. Colvin said there appeared to be some charges that UnitedHealthcare didn’t process correctly, which could lower his bill slightly.

Maria Gordon Shydlo, communications director for UnitedHealthcare, said Fentress is responsible for 100% of health costs up to his annual, in-network deductible, then pays a percentage of health costs in “coinsurance” until he reaches his out-of-pocket maximum. So he will owe around $7,900 on his bill, she said, and any new in-network care will be fully covered for the rest of the year.

A hospital representative suggested Fentress apply for financial assistance. She followed up by sending him a form, but it went to the wrong address because Fentress was in the process of moving.

In September, he said he was finally going to fill out the form and was optimistic he’d qualify.

The Takeaway: Insurance performs two functions for those lucky enough to have it. First, you get to take advantage of insurers’ negotiated rates. Second, the insurer pays the majority of your medical bills once you’ve met your deductible. It pays nothing before then. High-deductible plans have the lowest premiums, so they are attractive or are the only plans many patients can afford. But understand you will be asked to pay for everything except preventive care until you’ve hit that number. And your deductible may be only part of the picture: “Coinsurance” is the bulk of what Fentress owes.

Out-of-pocket maximums are regulated by federal law. In 2021, the maximum will be $8,550 for single coverage. Try to plan treatment and procedures with an eye on the calendar — people with chronic conditions and this kind of insurance could save a lot of money if they have an expensive surgery in December rather than January.

As always, if you face a big medical bill, ask about payment plans, financial aid and charity care. According to the Baptist Health system’s website, the uninsured and underinsured can get discounts. Those with incomes equivalent to 200%-400% of the federal poverty level — or $25,520-$51,040 for an individual — may be eligible for assistance.

If you don’t qualify for help, negotiate with the hospital anyway. Arm yourself with information about the going rate insurers pay for the care you received by consulting websites like Healthcare Bluebook or Fair Health.

As Fentress tries to move past his latest bill, he’s now worried about something else: racking up new bills if he contracts COVID-19 down the road as an essential worker with existing health problems and the same high-deductible insurance.

“I don’t have hope for a financially stable future,” he said. “It shouldn’t be such a struggle.”

Dan Weissmann, host of “An Arm and a Leg” podcast, reported the radio interview of this story. Joe Neel of NPR produced Sacha Pfeiffer’s interview with KHN Editor-in-Chief Elisabeth Rosenthal on “All Things Considered.”

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it! COPY HTML

ALERT!!!! Is Your Hospital Rated 1 Star by Medicare Their Lowest Rating!!!

CMS updated its Overall Hospital Quality Star Ratings Jan. 28, recognizing 228 hospitals with one star.

CMS’ Hospital Compare website reports on quality measures for more than 4,500 hospitals nationwide. Here is a breakdown of the updated star ratings:

  • One star: 228 hospitals
  • Two stars: 710 hospitals
  • Three stars: 1,191 hospitals
  • Four stars: 1,136 hospitals
  • Five stars: 407 hospitals

Below is a listing of CMS’ one-star hospitals, broken down by state, as listed on the Hospital Compare website. To view a list of CMS’ five-star hospitals, click here.

Arkansas

Baptist Health-Fort Smith

Chi-St. Vincent Infirmary (Little Rock)

Conway Regional Health System

Jefferson Regional Medical Center (Pine Bluff)

National Park Medical Center (Hot Springs)

St. Bernards Medical Center (Jonesboro)

Uams Medical Center (Little Rock) 

California

Adventist Health and Rideout (Marysville)

Antelope Valley Hospital (Lancaster)

Beverly Hospital (Montebello) 

Community Regional Medical Center (Fresno)

Doctors Hospital Of Riverside

Emanuel Medical Center (Turlock)

Hemet Valley Medical Center

Hollywood Presbyterian Medical Center (Los Angeles)

Kern Medical Center (Bakersfield)

LAC+USC Medical Center (Los Angeles)

Madera Community Hospital

Memorial Hospital Of Gardena

Menifee Global Medical Center (Sun City)

Mercy Hospital (Bakersfield)

Mercy Medical Center (Merced)

Mercy Medical Center Redding

O’Connor Hospital (San Jose)

Pioneers Memorial Healthcare District (Brawley)

Riverside University Health System-Medical Center (Moreno Valley)

San Joaquin General Hospital (French Camp)

San Leandro Hospital  

Sierra View Medical Center (Porterville)

St. Bernardine Medical Center (San Bernardino)

St. Joseph’s Medical Center (Stockton)

St. Mary Medical Center (Apple Valley) 

Twin Cities Community Hospital (Templeton)

USC Verdugo Hills Hospital (Glendale)

Victor Valley Global Medical Center (Victorville)

Zuckerberg San Francisco General Hospital and Trauma Center

Connecticut

Charlotte Hungerford Hospital (Torrington)

Waterbury Hospital 

Florida

AdventHealth Lake Wales 

AdventHealth New Smyrna Beach

Bayfront Health-Brooksville

Bayfront Health-Port Charlotte  

Bayfront Health-Punta Gorda 

Bayfront Health-Seven Rivers (Crystal River)

Blake Medical Center (Bradenton)

Boca Raton Regional Hospital

Broward Health Coral Springs  

Broward Health North (Pompano Beach)

Cleveland Clinic Martin North Hospital (Stuart)

Halifax Health Medical Center (Daytona Beach)

Jackson Memorial Hospital (Miami)

JFK Medical Center (Atlantis)

Lakeland Regional Medical Center

Lawnwood Regional Medical Center and Heart Institute (Fort Pierce)

Manatee Memorial Hospital (Bradenton)

North Shore Medical Center (Miami)

Parrish Medical Center (Titusville)

Steward Melbourne Hospital  

The Villages Regional Hospital 

Wellington Regional Medical Center 

Westside Regional Medical Center (Plantation)

Winter Haven Hospital

Georgia

Augusta University Medical Center (Augusta)

Coffee Regional Medical Center (Douglas)

Emory Decatur Hospital  

Grady Memorial Hospital (Atlanta)

The Medical Center, Navicent Health (Macon)

Memorial Health University Medical Center (Savannah)

Phoebe Putney Memorial Hospital (Albany)

Piedmont Columbus Regional-Midtown  

Piedmont Rockdale Hospital (Conyers)

Piedmont Walton Hospital (Monroe)

WellStar Atlanta Medical Center  

Iowa

St. Luke’s Regional Medical Center (Sioux City)

Illinois

Franciscan Health Olympia Fields

Gateway Regional Medical Center (Granite City)

Jackson Park Hospital (Chicago)

John H. Stroger Jr. Hospital (Chicago)

Louis A. Weiss Memorial Hospital (Chicago)

Mercy Hospital and Medical Center (Chicago) 

Mount Sinai Hospital (Chicago) 

OSF Saint Francis Medical Center (Peoria)

University of Illinois Hospital (Chicago)

Kansas

St. Catherine Hospital (Garden City)

Kentucky

Hazard ARH Regional Medical Center

Highlands Regional Medical Center (Prestonsburg)

Jennie Stuart Medical Center (Hopkinsville)

Paul B. Hall Regional Medical Center (Paintsville)

Pikeville Medical Center

The Medical Center at Bowling Green

University of Kentucky Hospital (Lexington)

University of Louisville Hospital

Louisiana

Jennings American Legion Hospital  

Ochsner LSU Health Shreveport

Tulane Medical Center (New Orleans)

University Medical Center New Orleans

Massachusetts

Good Samaritan Medical Center (Brockton)

MelroseWakefield Healthcare (Melrose)

Morton Hospital (Taunton)

Sturdy Memorial Hospital (Attleboro)

UMass Memorial Medical Center (Worcester)

Maryland

University of Maryland Prince George’s Hospital Center (Cheverly) 

University Of Maryland Medical Center (Baltimore) 

University Of Maryland Laurel Regional Hospital  

Michigan

Detroit Receiving Hospital and University Health Center

Hurley Medical Center (Flint)

Sinai-Grace Hospital (Detroit)

Mississippi

Baptist Memorial Hospital-Desoto (Southaven)

Delta Regional Medical Center (Greenville)

Forrest General Hospital (Hattiesburg)

Memorial Hospital at Gulfport  

Merit Health River Region (Vicksburg) 

Southwest Mississippi Regional Medical Center (McComb)

St. Dominic-Jackson Memorial Hospital 

University Of Mississippi Med Center (Jackson)

Missouri

Christian Hospital Northeast-Northwest (St. Louis)

Poplar Bluff Regional Medical Center

SoutheastHealth (Cape Girardeau)

SSM Health St. Louis University Hospital  

Nebraska

Regional West Medical Center (Scottsbluff)

Nevada

Desert Springs Hospital (Las Vegas)

Spring Valley Hospital Medical Center (Las Vegas)

Summerlin Hospital Medical Center (Las Vegas)

Sunrise Hospital And Medical Center (Las Vegas)

University Medical Center (Las Vegas)

Valley Hospital Medical Center (Las Vegas)

New Jersey

Carepoint Health-Christ Hospital (Jersey City)

Carepoint Health-Hoboken University Medical Center

East Orange General Hospital  

Hackettstown Medical Center  

Inspira Medical Center Vineland

JFK Medical Center-Anthony M. Yelencsics Community (Edison)

Salem Medical Center

St. Joseph’s University Medical Center (Paterson)

Trinitas Regional Medical Center (Elizabeth)

University Hospital (Newark)

New Mexico

MountainView Regional Medical Center (Las Cruces)

UNM Hospital (Albuquerque)

New York

Albany Medical Center Hospital

Alice Hyde Medical Center (Malone) 

Auburn Community Hospital

Bellevue Hospital Center (New York City)

Bronx-Lebanon Hospital Center (New York City)

Brookdale Hospital Medical Center (New York City)

Brooklyn Hospital Center at Downtown Campus (New York City)

Columbia Memorial Hospital (Hudson)

Coney Island Hospital Center (New York City)

Crouse Hospital (Syracuse)

Eastern Niagara Hospital (Lockport)

Ellis Hospital (Schenectady)

Elmhurst Hospital Center  

Faxton-St. Luke’s Healthcare (Utica)

Flushing Hospital Medical Center (New York City)

Geneva General Hospital

Good Samaritan Hospital Medical Center (West Islip)

Good Samaritan Hospital of Suffern

Harlem Hospital Center (New York City)

Interfaith Medical Center (New York City)

Jacobi Medical Center (New York City)

Jamaica Hospital Medical Center (New York City)

Jones Memorial Hospital (Wellsville)

Kings County Hospital Center (New York City)

Kingsbrook Jewish Medical Center (New York City)

Lincoln Medical & Mental Health Center (New York City)

Long Island Community Hospital (Patchogue)

Maimonides Medical Center (New York City)

Mary Imogene Bassett Hospital (Cooperstown)

Mercy Medical Center (Rockville Centre)

Montefiore Medical Center (New York City)

Nassau University Medical Center (East Meadow) 

Queens Hospital Center (New York City)

Richmond University Medical Center (New York City)

Rochester General Hospital 

St. Barnabas Hospital (New York City)

St. Catherine of Siena Medical Center (Smithtown)

St. Elizabeth Medical Center (Utica)

St. John’s Episcopal Hospital (New York City)

St. Joseph’s Medical Center (Yonkers)

Staten Island University Hospital (New York City)

United Health Services Hospitals (Binghamton)

University Hospital of Brooklyn-SUNY Downstate (New York City)

Vassar Brothers Medical Center (Poughkeepsie)

Westchester Medical Center (Valhalla)

Wyckoff Heights Medical Center (New York City)

North Carolina

Halifax Regional Medical Center (Roanoke Rapids)

Nash General Hospital (Rocky Mount)

Ohio

Clinton Memorial Hospital (Wilmington)

East Ohio Regional Hospital (Martins Ferry)

Trumbull Regional Medical Center (Warren)

University of Toledo Medical Center

Oklahoma

Comanche County Memorial Hospital (Lawton)

Hillcrest Medical Center (Tulsa)

OU Medicine (Oklahoma City)

Saint Francis Hospital Muskogee 

Pennsylvania

Albert Einstein Medical Center (Philadelphia)

Conemaugh Memorial Medical Center (Johnstown)

Hahnemann University Hospital (Philadelphia)

Pottstown Hospital  

Regional Hospital of Scranton  

Thomas Jefferson University Hospital (Philadelphia)

Wilkes-Barre General Hospital

Puerto Rico

Auxilio Mutuo Hospital (San Juan)

Doctors’ Center Hospital-San Juan 

Doctors’ Center Hospital (Manati)

Hima San Pablo-Bayamon 

Hima San Pablo-Caguas

Rhode Island

Rhode Island Hospital (Providence)

South Carolina

Trident Medical Center (Charleston)

The Regional Medical Center of Orangeburg and Calhoun (Orangeburg)

Tennessee

Holston Valley Medical Center (Kingsport)

Jackson-Madison County General Hospital  

Johnson City Medical Center  

Methodist Medical Center of Oak Ridge  

Texas

City Hospital at White Rock (Dallas)

Coleman County Medical Center  

HCA Houston Healthcare Tomball  

Huntsville Memorial Hospital  

Medical Center Hospital (Odessa)

Southwest General Hospital (San Antonio)

Virginia

Bon Secours Maryview Medical Center (Portsmouth)

Wisconsin

Ascension All Saints Hospital (Racine)

West Virginia

Charleston Area Medical Center

Wheeling Hospital

Washington, D.C.

George Washington University Hospital  

Howard University Hospital  

Medstar Georgetown University Hospital

Medstar Washington Hospital Center

HOW I ESCAPED THE BIG PHARMA PRISON


The team at Escaping the Healthcare Prison is dedicated to showing how healthcare consumers can escape their PRISON. Each of us has been a healthcare prisoner one time or another.  The spectrum of issues is endless.  Our monthly ESCAPE PLANS will help you navigate the healthcare maze. 

HOW I ESCAPED THE BIG PHARMA PRISON

BACK ROUND:

Jim, a 59-year-old male recently had his yearly check up with his specialty doctor.   Jim and his doctor were reviewing his prescriptions of which one was specialty drug not covered by his insurance.  Jim asked his doctor to renew all his prescriptions with his local Pharmacy.  The specialty drug was included.  Jim knew the drug was not covered under is insurance plan. Jim had never bought the prescription because it was of the high cost.

SEVERAL DAYS LATER:

Jim received a call from the Pharmacy that his prescriptions were ready, but the specialty drug was not covered.  They advised him to find a coupon and bring it in.  Jim heard about companies that helped consumers reduce their drug costs. Jim looked up the drug on Good RX and found a coupon for 30 pills for $19.85. Jim printed the coupon and went to Pharmacy.

THE PHARMACY:

Jim arrived at the pharmacy to pick up his prescription. The pharmacist told Jim prescription for his speciality drug was priced at $2,164.49 for 30 pills.  This is the cash and carry price. They asked Jim if he brought in a coupon.  Jim presented the Good RX coupon, the Pharmacy accepted it and Jim paid $19.85. Jim saved $2,144.64. Remember, in previous years Jim never bought the prescription because it was too expensive, and he did not realize how Good RX works.  Also, congratulations to Pharmacy for suggesting to Jim to check on coupons. 

TAKE AWAY REGARDING PRESCITIONS:

  1. Always check on Good RX or similar companies the cost of your prescription and compare the Good RX cost with your insurance co pays.  You may be surprised to find out that they are cheaper.
  2. If you do not have insurance or your insurance will not cover the prescription, always check Good RX or other similar companies. 
  3. Shopping healthcare is the future.  Start small and work up to the bigger purchases. 

Your team at Escaping the Healthcare Prison is always there to help the consumer.  Use our website to let us know how we can help.

www.escapingthehealthcareprison.org


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