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Essential Worker Shoulders $1,840 Pandemic Debt Due To COVID Cost Loophole By: Kaiser Health News

Carmen Quintero works an early shift at a distribution warehouse that ships N95 masks and other products to a nation under siege from the coronavirus. On March 23, she developed a severe cough, and her voice, usually quick and enthusiastic, was barely a whisper.

A human resources staff member told Quintero she needed to go home.

“They told me I couldn’t come back until I was tested,” said Quintero, who was also told she would need to document that she didn’t have the virus.

Her primary care doctor directed her to the nearest emergency room for testing because the practice had no coronavirus tests.

The Corona Regional Medical Center is just around the corner from her house in Corona, California, and there a nurse tested her breathing and gave her a chest X-ray. But the hospital didn’t have any tests either, and the nurse told her to go to Riverside County’s public health department. There, a public health worker gave her an 800 number to call to schedule a test. The earliest the county could test her was April 7, more than two weeks later.

At the hospital, Quintero got a doctor’s note saying she should stay home from work for a week, and she was told to behave as if she had COVID-19, isolating herself from vulnerable household members. That was difficult — Quintero lives with her grandmother and her girlfriend’s parents — but she managed. No one else in her home got sick, and by the time April 7 came, she felt better and decided not to get the coronavirus test.

Then the bill came.

The Patient: Carmen Quintero, 35, of Corona, California, who works at a distribution warehouse. She has an Anthem Blue Cross health insurance plan through her job with a $3,500 annual deductible.

Total Bill: Corona Regional Medical Center billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an additional $830 for physician services. She also paid $50 at Walgreens to fill a prescription for an inhaler.

Service Provider: Corona Regional Medical Center, a for-profit hospital owned by Universal Health Services, a company based in King of Prussia, Pennsylvania, that is one of the largest health care management companies in the nation. The hospital contracts with Corona Regional Emergency Medical Associates, part of Emergent Medical Associates.

Medical Service: Quintero was evaluated in the emergency room for symptoms consistent with COVID-19: a wracking cough and difficulty breathing. She had a chest X-ray and a breathing treatment and was prescribed an inhaler. What Gives: On that day in late March when her body shook from coughing, Quintero’s immediate worry was infecting her family, especially her girlfriend’s parents, both over 65, and her 84-year-old grandmother.

“If something was to happen to them, I don’t know if I would have been able to live with it,” said Quintero.

Quintero wanted to isolate in a hotel, but she could hardly afford to for the week that she stayed home. She had only three paid sick days and was forced to take vacation time until her symptoms subsided and she was allowed back at work. At the time, few places provided publicly funded hotel rooms for sick people to isolate, and Quintero was not offered any help.

For her medical care, Quintero knew she had a high-deductible plan yet felt she had no choice but to follow her doctor’s advice and go to the nearest emergency room to get tested. She assumed she would get the test and not have to pay. Congress had passed the CARES Act just the week before, with its headlines saying coronavirus testing would be free.

That legislation turned out to be riddled with loopholes, especially for people like Quintero who needed and wanted a coronavirus test but couldn’t get one early in the pandemic.

“I just didn’t think it was fair because I went in there to get tested,” she said.

Some insurance companies are voluntarily reducing copayments for COVID-related emergency room visits. Quintero said her insurer, Anthem Blue Cross, would not reduce her bill. Anthem would not discuss the case until Quintero signed its own privacy waiver; it would not accept a signed standard waiver KHN uses. The hospital would not discuss the bill with a reporter unless Quintero could also be on the phone, something that has yet to be arranged around Quintero’s workday, which begins at 4 a.m. and ends at 3:30 p.m.

Three states have gone further than Congress to waive cost sharing for testing and diagnosis of pneumonia and influenza, given these illnesses are often mistaken for COVID-19. California is not one of them, and because Quintero’s employer is self-insured — the company pays for health services directly from its own funds — it is exempt from state directives anyway. The U.S. Department of Labor regulates all self-funded insurance plans. In 2019, nearly 2 in 3 covered workers were in these types of plans.

Resolution: As lockdown restrictions ease and coronavirus cases rise around the country, public health officials say quickly isolating sick people before the virus spreads through families is essential.

But isolation efforts have gotten little attention in the U.S. Nearly all local health departments, including that of Riverside County, where Quintero lives, now have these programs, according to the National Association of County and City Health Officials. Many were designed to shelter people experiencing homelessness but can be used to isolate others.

Raymond Niaura, interim chairman of the Department of Epidemiology at New York University, said these programs are used inconsistently and have been poorly promoted to the public.

“No one has done this before and a lot of what’s happening is that people are making it up as they go along,” said Niaura. “We’ve just never been in a circumstance like this.”

Quintero still worries about bringing the virus home to her family and fears being in the same room with her grandmother. Quintero works at a warehouse that distributes 3M products including personal protective equipment and other companies’ products. Quintero returns from work every day now, puts her clothes in a separate hamper and diligently washes her hands before she interacts with anyone.

The bills have been another constant worry. Quintero called the hospital and her insurance company and complained that she should not have to pay since she was seeking a test on her doctor’s orders. Neither budged, and the bills labeled “payment reminders” soon became “final notices.” She reluctantly agreed to pay $100 a month toward her balance — $50 to the hospital and $50 to the doctors.

“None of them wanted to work with me,” Quintero said. “I just have to give the first payment on each bill so they wouldn’t send me to collections.”

The Takeaway: If you suspect you have COVID-19 and need to isolate to protect vulnerable members of your household, call your local public health department. Most counties have isolation and quarantine programs, but these resources are not well known. You may be placed in a hotel, recreational vehicle or other type of housing while you wait out the infection period. You do not need to have a positive COVID test to qualify for these programs and can use these programs while you await your test result. But this is an area in which public health officials repeatedly offer clear guidance — 14 days of isolation — which most people find impossible to follow.

At this point in the pandemic, tests are more widely available and federal law is very clearly on your side: You should not be charged any cost sharing for a coronavirus test.

Be wary, though, if your doctor directs you to the emergency room for a COVID test, because any additional care you get there could come at a high price. Ask if there are any other testing sites available.

If you do find yourself with a big bill related to suspected COVID-19, push beyond a telephone call with your insurance company and file a formal appeal. If you feel comfortable, ask your employer’s human resources staff to argue on your behalf. Then, call the help line for your state insurance commissioner and file a separate appeal. Press insurers — and big companies that offer self-insured plans — to follow the spirit of the law, even if the letter of the law seems to let them off the hook.

Bill of the Month is a crowdsourced investigation by Kaiser Health News 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

1 in 4 doctors say prior authorization has led to a serious adverse event

FEB 5, 2019

Andis Robeznieks

Senior News Writer

American Medical Association


It just keeps getting worse. That’s a major finding of an AMA survey of 1,000 practicing physicians who were asked about the impact prior authorization (PA) is having on their ability to help their patients. 

More than nine in 10 respondents said PA had a significant or somewhat negative clinical impact, with 28 percent reporting that prior authorization had led to a serious adverse event such as a death, hospitalization, disability or permanent bodily damage, or other life-threatening event for a patient in their care. 

PA, a health plan cost-control process, restricts access to treatments, drugs and services. This process requires physicians to obtain approval prior to the delivery of the prescribed treatment, test or medical service in order to qualify for payment. 

Traditionally, health plans applied PA to newer, expensive services and medications. However, physicians report an increase in the volume of prior authorizations in recent years, to include requirements for drugs and services that are neither new nor costly.  

The vast majority of physicians (86 percent) described the administrative burden associated with prior authorization as “high or extremely high,” and 88 percent said the burden has gone up in the last five years. 

“The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care,” said AMA Board of Trustees Chair Jack Resneck Jr., MD. “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality health care they need.” 

“The AMA is committed to attacking the dysfunction in health care by removing the obstacles and burdens that interfere with patient care,” Dr. Resneck added. “To make the patient-physician relationship more valued than paperwork, the AMA has taken a leading role by creating collaborative solutions to right-size and streamline prior authorization and help patients access safe, timely and affordable care, while reducing administrative burdens that pull physicians away from patient care.” 

The AMA offers prior-authorization reform resources that allow physicians to make a difference with effective advocacy tools, including model legislation and an up-to-date list of state laws governing prior authorization.  

Share  your story with the AMA about PA’s impact on your practice and your patients to help #FixPriorAuth. Visit to learn more.

Other highlights of the AMA physician survey include that: 

  • 91 percent believe that PA delays patients’ access to care. 
  • 75 percent reported that PA can lead to patients abandoning their course of treatment. 

The AMA survey was conducted online in December 2018. Participants were physicians who practice in the United States, provide at least 20 hours of direct patient care and complete PAs during a typical week of practice. Forty percent of participants were primary care physicians, and 60 percent were in other specialties.  

Physicians’ views on the impact of care delays comes into focus when one considers the typical turnaround times they see from health plans.

In the AMA survey: 

  • 65 percent of physicians said they wait an average of at least one business day for a prior-authorization decision from a health plan. 
  • 26 percent reported waiting at least three days. 
  • 7 percent reported waiting an average of more than five days. 

Physicians in the survey reported processing an average 31 PAs per week, with this PA workload consuming 14.9 hours—nearly two business days—of physician and staff time. 

Additionally, 36 percent reported that their practice has staff who work exclusively on PA.  

In January 2017, the AMA with 16 other associations urged industry-wide improvements in prior authorization programs to align with a newly created set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. More than 100 other health care organizations have supported those principles. 

In January 2018, the AMA joined the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association in a consensus statement outlining a shared commitment to industry-wide improvements to prior authorization processes and patient-centered care. 

From Prisoner to Customer to Sophisticated Consumer

The coronavirus is providing us with a great opportunity to understand why it is so important for each person to have a healthcare plan. We have all been exposed to a rare opportunity to view how healthcare providers run the “business of healthcare.” We are also witnessing the oftentimes recalcitrant behavior of healthcare patients and the potential hazards of these actions.

Since 1983, the federal government changed the reimbursement formula for how healthcare providers were paid by Medicare from a reimbursement model to a prospective payment model. The most dramatic and observable impact of this new legislation was dropping hospital occupancy from around 80% to 63% in just 3 years. This change set in motion numerous responses and reactions by the healthcare system that continue to evolve today and more importantly have been exposed by the pandemic. On the downside, this over capacity has led to the closure of many hospitals, the consolidation of many more and the creation of mega-multi-hospital systems. There would also be a physician glut of specialists and simultaneously a shortage of primary care physicians. A nursing shortage was also becoming a concern and the emergence of what would be called a “healthcare customer” vs. a healthcare patient. This all created a massive change in healthcare terminology. Customer satisfaction became a thing, patients would become guests, guest relationship training became in vogue,  amenities like valet parking, escort services, hotel quality bed linen and towels, concierge level floors were all part of a hospital’s  marketing approach to the new healthcare customer.

Here’s the shocking surprise to this story. The implementation of the new Medicare payment methodology was a cost-control initiative. In 1986, the US spent $458 billion or 10.9% of the gross national product (GNP) on healthcare. By 2019, this number escalated to an estimated $3.6 trillion and with the pandemic $4.0 trillion is certainly within range for 2020. To put this in personal terms, according to the Milliman Medical Index the average cost for a family of four covered by an employer-sponsored, preferred provider organization plan was $28,166 in 2018. Using some over-simplistic ratio analysis a comparative number in 1986 would be approximately $3,600. This is an inflation factor of 782%. This unintended consequence resulted in the passage of what has become known as Obamacare in March 2010. The official name, The Patient Protection and Affordable Care Act, was the most extensive healthcare legislation since the aforementioned change in the Medicare payment methodology. The focus of the legislation was on the uninsured, improving quality and again the holy grail of controlling healthcare costs. This has continued to be a very challenging political issue and we will not discuss all of the continuing issues this has created.

Ironically, healthcare in the US is still broken as evidenced by the current chaos being caused by the pandemic. It’s become evident that $3.6 trillion isn’t enough to handle a crisis. Healthcare will be a major issue in the 2020 presidential race. As an industry, the focus continues to largely be internal with massive doses of superficial rhetoric surrounding quality, patient safety and customer satisfaction.

A little discussed factor underlying the healthcare system is that it’s the most financially driven industry in America. As of now, Congress has allocated $175 billion in aid to hospital and healthcare providers as a result of the pandemic. A further example of how “economics” drive healthcare was included in the Affordable Care Act. In a little publicized program initiated in 2014 and called, The Hospital-Acquired Condition Reduction Program, CMS began reducing Medicare payments based on the performance on 6 quality measures. This is one of the few public data bases reflecting a hospital’s quality performance and was created by a financial incentive program. Buyer beware!

With this background, we are introducing an initiative to create a class of sophisticated healthcare consumers. As is being illustrated everyday during the current medical crisis, decisions people make about medical care can have life and death consequences.

Let’s get started.

Our first recommendation is “Document Your Family’s Health History.”

Find an App, get a three-ring binder or start a journal. Anytime a person goes to a physician’s office for the the first time they will be asked to complete a medical history template. This information is the critical first step to any physician’s diagnostic process. Go on-line and there are numerous examples and tools to assist in this process. With chronic conditions being important mortality factors in the current coronavirus environment, knowing what family members have what conditions are critical. Decisions regarding genetic testing also are a consideration in today’s environment. If you’re quarantined, it’s a great opportunity to complete this project.

Next, we’ll focus on primary care physician selection.

EXAMPLE OF A HEALTHCARE PRISON; Health Insurers Prosper As COVID-19 Deflates Demand For Elective Treatments

Published by: Kaiser Family Foundation

As doctors and consumers are forced to put most nonemergency procedures on hold, many health insurers foresee strong profits.

So why is the industry looking to Congress for help?

Insurers say that while that falloff in claims for non-COVID care is offsetting for now many insurers’ costs associated with the pandemic, the future is far more fraught.

Costs could remain modest or quickly outstrip savings. A recession could drive revenue down. Or the coronavirus could resurge next winter and spike treatment expenses.

All that uncertainty for the companies could trigger far higher premiums for consumers, if insurers hedge their bets. Then again, the current savings insurers are seeing — along with cautions from state regulators about pushing cost-sensitive customers away during an economic downturn — might result in minimal premium increases.

“Insurers are nervous, to be sure,” said Michael Kreidler, Washington state’s insurance commissioner. “But so far they are telling me they are in good shape. Coronavirus claims have not been that high — yet.”

Backing that assessment was a report out last week by credit rating agency Moody’s, which looked at a range of pandemic scenarios — from mild to severe — and concluded “U.S. health insurers will nonetheless remain profitable under the most likely scenarios.”

Earlier this month, UnitedHealth Group CEO David Wichmann told analysts that cost reductions so far are outstripping expenses for COVID-19 and that revenue is up compared with the previous year. He expects — barring a worsening situation — the rest of the year’s earnings to match projections. Other insurers, including Centene, Anthem, Humana and Cigna, are scheduled to release earnings reports this week.

If these results are repeated across the insurance industry, there will be pressure on insurers to hold down rate increases for next year and do more for policyholders, such as constrain the growth in deductibles and other out-of-pocket costs, said consumer advocates, regulators and policy experts.

“The last thing we need is insurers pricing their coverage unnecessarily high at a time like this,” said Peter Lee, executive director of Covered California, the health insurance marketplace in that state for people who buy their own coverage because they don’t get it through their job.

That prediction comes as tens of millions of Americans have lost their jobs — and often their health insurance.

Those thrown out of work may be able to stay on employer coverage through a federal law called COBRA, but it’s expensive and workers have to foot the bill. Insurers and employers have asked Congress for relief legislation to fully cover COBRA costs.

Losing a job is also a qualifying event to enroll in an Affordable Care Act plan — and, again, the industry has asked lawmakers to temporarily boost subsidies to help enrollees pay their premiums. Some states that run their own ACA marketplaces have reopened enrollment to help the uninsured get coverage.

The industry also wants Congress to authorize temporary financial support to help cover insurers that face “extraordinary, unplanned costs in 2020 and 2021,” according to a letter sent to lawmakers from America’s Health Insurance Plans and the Blue Cross Blue Shield Association.

To help, some states are giving insurers more time this year to submit their planned premium rates for 2021 — based on their expected costs — hoping things may be clearer by summer. California, for instance, is giving insurers until July to draw up their estimates.

One fear is that insurance actuaries, when faced with an unknown risk like the coronaviruswill price higher than needed, said Lee.

Setting premiums for next year is a balancing act. Insurers that calculate incorrectly and go too low will lose profits and may have to dig into their cash reserves to pay claims. If they set rates too high, they may run afoul of a provision in the ACA that requires insurers to issue rebates to policyholders if they don’t spend at least 80% of revenue on medical care.

And they don’t estimate well even in normal years. Early data for 2019 coverage shows insurers may owe a record amount in rebates, which will be paid out this year.

Insurers are not talking about next year’s premiums.

“We do not yet know the full scope, severity or duration of this outbreak. So we cannot know the ultimate cost of our members’ medical treatment or how long the postponement of non-urgent care will continue,” said Justine Handelman, senior vice president at the Blue Cross Blue Shield Association.

Early estimates, including a scary one from Covered California issued in late March, warned that costs associated with the coronavirus could drive premiums up 40% next year without federal help, based on initial models of the number of Americans who might fall seriously ill.

That report, though, did not take into account the effect of the sharp decline in elective care.

Thirty-one states have barred most elective surgeries, part of the effort by governors to promote social distancing to flatten the curve of the epidemic and to help prevent hospitals from being overwhelmed.

“The good news since we published that report is that it looks like efforts to flatten the curve are taking effect,” said Lee, so costs are more likely to be in the median rather than high end of the range.

The cost to insurers “all depends on the severity” of the continuing pandemic, said Dean Ungar, a vice president and senior credit officer at Moody’s. “On the lower side, the industry will do quite well, and also even in a more median scenario, especially when you factor in the offsetting benefit of delayed procedures.”

Moody’s estimates that deferred elective procedures may account for as much as 20% to 40% savings on medical costs per month for many insurers as long as elective procedures are barred or patients are unwilling to seek nonemergency care.

Even so, “I don’t think the insurance industry as a whole has any intention of making money off this,” Ungar said. “There will be rebates or other things to help. Partly that’s the right thing to do and partly it’s good business.”

Former Cigna executive turned industry critic Wendell Potter disagreed. He tweeted earlier this month that UnitedHealth spent $1.7 billion during the first quarter to buy back its own stock — a move that helps the company. “In other words, they’re thriving during a pandemic,” Potter tweeted. Instead, he said, the insurer should plow that money into premium reductions or other help for policyholders.

For its part, UnitedHealth said it has waived patient cost sharing for COVID care — as have most other insurers — as well as accelerated payments for what it owes to doctors, and is helping provide loans to some clinics.

Some physician groups fear they are being left out, saying some of the savings seen by insurers and self-insured employers should be directed to those struggling after seeing their practices dry up as people avoid medical care or governors bar elective procedures.

“It’s a huge hit,” said Tom Banning, CEO and executive vice president of the Texas Academy of Family Physicians.

Lee agreed, warning that struggling front-line physicians, and especially family and primary care doctors, will need financial help.

“A bad outcome of all this will be if thousands of providers can’t make it financially and their practices get bought up by hospitals or private entities — creating more consolidation in health care, which is already driving costs up,” said Lee. “Lawmakers should be thinking about helping primary providers out.” COPY HTML

HOSPITALS ARE HEALTHCARE PRISONS: Amid Coronavirus Distress, Wealthy Hospitals Hoard Millions


Inova Health System, with campuses in some of the wealthiest suburbs of Washington, D.C., and Truman Medical Centers, a safety-net hospital in downtown Kansas City, Missouri, have little in common. But, today, they are confronting the same financial plague: mass cancellations of nonessential surgeries that are their biggest moneymakers while bracing for an expensive onslaught of coronavirus patients.

Yet Truman has less than a month’s worth of cash reserves to keep it afloat while Inova entered the outbreak with enough money to operate for at least 21 months, according to Inova’s financial disclosure for 2019, before the stock market decline. At that time, Inova told its bondholders it had $3.1 billion in investments it could liquidate within three days. Tapping any of that may never be necessary because Inova also drew down its entire $238 million line of credit earlier this year to prepare for the pandemic.

“At the end of the day, not all hospitals are created equal,” said Charlie Shields, Truman’s president and CEO. “If you were sitting on a year of … cash on hand, that would not be as challenging, but most safety-net hospitals are south of 25 days, and we’re probably around 10. How do you manage through that?”

But Dr. J. Stephen Jones, Inova’s president and CEO, said, “Our finances are a mess at this point,” with the system postponing non-urgent treatments and eliminating 427 administration and management positions.

“This is an existential threat to every health care organization, no matter how strong they come into it,” said Jones, who cut his own salary by 25%.

As the coronavirus wreaks havoc with hospital finances, wealthy hospitals sitting on millions or even billions of dollars are in a competitive stampede against near-insolvent hospitals for the same limited pots of financial relief. Those include the $175 billion bailout fund Congress allotted for health care providers as part of two recent coronavirus packages and loans from private ban

Certainly, even the richest hospitals are having their balance sheets despoiled by a triple punch: the stock market slump, the cost of preparation for coronavirus patients and the cessation of profitable surgeries, which is costing many hospitals half or more of their revenues. Inova, for instance, has spent $32 million to buy personal protective equipment and install negative air pressure systems in 200 hospital rooms, Jones said. (As of Monday morning, the system had 323 coronavirus patients.)

But unlike safety-net and smaller hospitals, many big health systems have the resources to stay afloat without financial assistance through the summer and beyond. Half of the 284 hospitals whose bonds Moody’s Investors Service rated in 2018 had enough cash on hand to cover six months or more.

They also don’t have to rely for survival on revenue from only treating patients. Before the stock market drop, 365 hospitals — about one of every 13 — reported an investment portfolio exceeding $100 million, according to a Kaiser Health News analysis of hospital cost reports from 2018 filed with Medicare. Together, those investments pumped $2.8 billion into those hospitals that year.

“A lot of the big hospitals have developed fortress balance sheets since the financial crisis” of 2008, said Chas Roades, co-founder and CEO of Gist Healthcare, a consulting firm. “The reflex is to protect the operation.” But, he said, “if that’s a rainy day fund, it’s raining pretty hard right now.”

The wealthier hospitals face sacrifices that other hospitals might envy, such as having to postpone ambitious building projects or adding to their already large investment portfolios. They are less concerned with running out of money than with depleting their cash reservoirs so much that their credit ratings would be downgraded, which could lead to higher borrowing costs.

“Most would prefer to have a line of credit than liquidate a stock holding,” said Lisa Goldstein, an associate managing director at Moody’s.

UCHealth, a 12-hospital nonprofit system in Colorado, has temporarily stopped contributing to its investments, which as of the end of last year totaled more than $544 million in cash and liquid investments and $4 billion in long-term investments, according to its financial disclosure report. Even before the pandemic, it had been stockpiling extra cash to build an 11-story tower at the University of Colorado Hospital in Denver that will cost $388 million, said Dan Rieber, UCHealth’s chief financial officer. The system has enough liquidity to operate for more than 300 days without any new income and has obtained new lines of credit.

But when large health systems draw down those lines of credit, it makes it harder for smaller hospitals to get private aid because lenders may be tapped out, said Christopher Kerns, a vice president at Advisory Board, a health care consulting firm. “In our own discussions with lenders, there’s only so much cash that’s available, and that is putting the squeeze on the small or midsize organizations, and they are finding themselves very crushed,” Kerns said.

The federal Health and Human Services Department has not made financial leeway assets a factor in deciding how it will distribute the $100 billion bailout fund passed in March. The department is doling out the first $30 billion based on how much each health care provider was paid by Medicare last year. The department plans to distribute the remaining money with an eye toward the prevalence of coronavirus infections in a hospital or region, and in the number of low-income and uninsured patients. The latest federal stimulus package — signed by President Donald Trump on Friday — added $75 billion to the relief fund.

“There isn’t a mechanism right now to distinguish between the exceedingly well-endowed hospitals and those that are struggling,” said Dan Mendelson, founder of the consulting company Avalere Health and a private equity investor.

The association representing safety-net hospitals, America’s Essential Hospitals, has urged that cash reserves be a factor in divvying up the money, which is widely viewed as insufficient to cover all hospitals’ costs. Some member hospitals have fewer than 10 days of cash reserves and run on average margins of 1.6%, a fifth of the industry average, according to the group.

“Our hospitals are struggling now to manage surging patient volume, staff and supply shortages, and other severe challenges as their limited cash reserves dwindle,” Dr. Bruce Siegel, the association’s president, said in a statement.

Certainly, even the wealthiest hospitals are seeing their robust balance sheets being turned upside down. Following the guidance of the federal government, UCHealth has postponed elective surgeries, leading to a drop in business of 50% to 60%. Elizabeth Concordia, UCHealth’s CEO, said the system expects that it will not completely rebound even when the pandemic has diminished because many older people will be reluctant to return for elective surgeries for fear they might become infected with the coronavirus.

She said UCHealth is also on the front lines of fighting the pandemic. It currently has admitted 240 COVID-19 patients, more than any other Colorado hospital, and has been analyzing tests for rural hospitals without yet setting a contract for how much it will be reimbursed. It has also maintained its 25,000-person workforce without imposing pay reductions or furloughs.

“COVID is having a devastating impact on all of our finances,” Concordia said.

But for those hospitals with their own wealth, investment earnings can provide a buffer that most hospitals don’t have. In a forthcoming paper in the Journal of General Internal Medicine, researchers at the Johns Hopkins Bloomberg School of Public Health led by Ge Bai found that nearly all investment earnings for nonprofit hospitals were earned by just a quarter of the hospitals. Without that amount, their aggregate net income would have been 31% lower.

Investment income made up 5% of the total revenue for Trinity Health, a 92-hospital Catholic system based in Michigan and operating in 22 states, according to its financial disclosures to bondholders covering the last six months of 2019. Those investment earnings of $468 million accounted for 58% of Trinity’s surplus.

As of December, Trinity had $9.6 billion in cash and investments, enough to operate for six months. It also reported credit lines totaling $1.2 billion. Trinity did not respond to requests for comment.

The wealthier hospital systems are strongly positioned to take full advantage of whatever method the government sets for distributing the remainder of the bailout funds. They employ more reimbursement staff and have in place sophisticated methods to document every expense that they can attribute to the coronavirus response, said Simone Rauscher Singh, an assistant professor at the University of Michigan School of Public Health.

“The big hospitals are ramping up their capacity to document all this so they can go back later and say, ‘This is what we spent,’” she said. “The small hospitals are going to be in an even worse position to do that.”


Jordan Rau: [email protected]@JordanRau

In Fine Print, HHS Appears To Ban All Surprise Billing During The Pandemic

Federal officials offering emergency funding to hospitals, clinics and doctors’ practices have included this stipulation: They cannot foist surprise medical bills on COVID-19 patients.

But buried in the Department of Health and Human Services’ terms and conditions for eligibility is language that could carry much broader implications. It says “HHS broadly views every patient as a possible case of COVID-19,” the guidance states.

Some say that line could disrupt a longtime health care industry practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays, a major source of surprise bills ― which can be financially devastating ― for patients. It is banned in several states, though not federally.

For those immersed in the ongoing fight over surprise medical billing, the possibility that HHS might have done with fine print what Congress and the White House could not do with bipartisan support and ample public outrage caught some off-guard and raised questions about what exactly HHS meant.

As the first wave of $30 billion in payouts began to hit bank accounts last week, providers were asked to sign an online form agreeing to the government’s terms. Among those terms is that, “for all care for a possible or actual case of COVID-19,” the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with their insurance company.

The agreement is posted on the page.

“The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19,” an HHS spokesperson said late Friday. “We are clarifying this in the terms and conditions.”

Lobbyists, advocates and other experts say the ambiguity could be enough to mandate that providers who accept federal funds have agreed not to send surprise medical bills to patients — whether or not they test positive for COVID-19.

“If you took the broadest interpretation, any of us could be a potential patient,” said Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.

Last week, as HHS released an initial draft of its terms and conditions for the emergency funds allocated by Congress in the CARES Act, the Trump administration startled many in health care by declaring that providers would have to agree not to send surprise bills to COVID-19 patients for treatment. A White House spokesperson declined to comment.

But the blanket assertion by health officials that “every patient” is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration’s announcement and open the door to lawsuits over whether HHS intended to ban balance billing entirely.

“Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision,” said Rodney Whitlock, a health policy consultant and former Senate staffer.

Some providers and others in the health care industry have fought tooth and nail to safeguard their control over what they can bill patients for care. Dark-money groups, later revealed to be connected to physician staffing firms owned by profit-driven private equity firms, spent millions last summer to buy political ads targeting members of Congress who were working on legislation to end surprise billing.

Congress has yet to pass any legislation on the matter, but the debate is ongoing behind the scenes. Lawmakers included modest protections against being billed for COVID-19 testing in relief legislation but declined to go further.

Hoadley of Georgetown said HHS’ guidance should address some of the problems that Congress did not account for explicitly in its relief legislation, such as cases of patients being billed for testing for COVID-19 when the test results were negative.

“The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients,” Hoadley said. “That’s going to affect our willingness to” seek testing or treatment, he said.

Frederick Isasi, executive director of Families USA, a nonprofit that advocates for health care consumers, said the group supports the administration’s guidance “wholeheartedly” but urged lawmakers to enshrine broad protections against surprise billing into law.

“It’s time to just ban them permanently, not just related to COVID,” Isasi said, adding: “Families should avail themselves of this as broadly as possible.” COPY HTML

Dealing with debt collectors during the pandemic

This Blog was published by: THE FEDERAL TRADE COMMISSION….Consumer helpful

April 22, 2020 by Seena Gressin Attorney, Division of Consumer & Business Education, FTC

Job losses have traveled hand-in-hand with the Coronavirus. If you’re having trouble paying your bills, you’re not alone. Here are a few things to keep in mind if a debt collector calls.

Consider talking with the collector at least once, even if you can’t pay right away or don’t think you owe the money. That way, you can confirm whether it’s really your debt. If it is, you may be able to work out a payment plan or settlement.

Collectors have to follow rules when they contact you. Watch the short video at the end of this post to learn about these rules. During the Coronavirus emergency, the federal government and many state and local governments also have put special programs in place that may help you manage your debt:

  • The Department of Education (ED) has temporarily stopped the collection of federally-owned student loans that are in default. In fact, whether or not you’re in default, if you have federal student loans, you don’t need to pay your monthly payments from March 13 through September 30, 2020, and interest also has been suspended. Visit ED’s website to learn more.
  • Some states are limiting what collectors can do during this emergency. For example, you’ve probably heard about the $1,200 economic stimulus payments that most people will get as a direct deposit to their bank account. If a debt collector or a creditor has sued you, they may have a garnishment order that would let them seize the payment when it reaches your account. Some states, however, are temporarily making debt collection seizures like this illegal. Check with your state attorney general to find out about any emergency limits on debt collection actions in your state. (A new IRS “Get My Payment” tool lets you track the payment to your account.)
  • Many state and local governments have temporarily halted actions like evictions, foreclosures, and water and utility shutoffs. Contact your state and local government to find out about emergency protections that may apply to you.

If the collection calls get to be too much, you can stop them. Just send the collector a letter telling them to stop contacting you. Keep a copy for your records. Stopping the calls won’t cancel the debt. You still might be sued or have debt reported to a credit bureau. But, stopping the calls may give you time to regroup, then start working your way toward financial recovery.

New federal rules will let patients put medical records on smartphones

  • MAR 11, 2020

This article is a GAME CHANGER for the Healthcare Consumer.

Federal officials on Monday released groundbreaking rules that will let patients download their electronic health records and other health care data onto their smartphones.

“Patients should have control of their records, period. Now that’s becoming a reality,” said Health and Human Services Secretary Alex Azar. “These rules are the start of a new chapter in how patients experience American health care.”

Officials said the rules likely will give patients a greater say in health care decisions and put an end to a long-standing practice in which some doctors and hospitals resist handing complete medical files over to patients upon demand. Many of the provisions are set to take effect in 2022.

“The days of patients being kept in the dark are over,” said Centers for Medicare & Medicaid Services Administrator Seema Verma. “In today’s digital age, our health system’s data-sharing capacity shouldn’t be mired in the Stone Age.”

Yet the new rules also have raised concerns about privacy as technology companies, such as Google, Microsoft, Apple and Amazon, open up new markets for providing medical records through mobile apps. Major EHR vendor Epic, for instance, has warned that freer flow of medical records could spur the unwanted sale of data or other unauthorized uses.

“Family members may be shocked to find that their most personal health data has been mined and sold by data brokers and is now known by others, Epic CEO Judy Faulkner wrote last June in opposing the rules.

Administration officials said they have taken privacy considerations into account and would require developers to attest to plans to protect the security and use of medical data.

Verma took a swipe at Epic in an interview with Kaiser Health News and Fortune.

“We’re not afraid to take on special interests to do what’s right for patients. Some people disagree because they want to keep the data,” she said. “The reality is that patient data belongs to patients. It doesn’t belong to EHR companies.”

Verma said the nation’s health care system remains “hugely expensive and inefficient as repeat tests drive up costs and, perhaps most importantly, doctors are forced to provide care with an incomplete clinical picture, especially at a time when the health care systems could be under stress.”

“With the handling of the COVID virus, the urgent need for coordinated integrated care could not be clearer,” she said.

Donald Rucker, who coordinates health information technology policy for HHS, said the new rule “will allow patients the ability to manage their health care the same way they manage their finances or the travel or other parts of their life on their smartphone.”

While Epic, the maker of the most-used electronic health records software, led a campaign to derail the rules, its chief competitor, Cerner Corp., argued the rules were long overdue.

“Consumers should have the right to access the health care information their providers have about them and dictate where they want it to go. Although existing laws allow patients to access their data, it doesn’t work,” Cerner CEO Brent Shafer said in a statement.

The rules also attempt to prevent EHR vendors from silencing critics of their software products. The government wants to encourage doctors and other users of EHR technology to share their experiences about software problems by prohibiting so-called gag clauses in sales contracts. That could free users to criticize EHR systems, including more open discussion of flaws, software glitches and other breakdowns.

Botched Operation,” an investigation published by Kaiser Health News and Fortune last year, found that the federal government has spent more than $36 billion on the EHR initiative. Thousands of reports of deaths, injuries and near misses linked to digital systems have piled up in databases over the past decade — while many patients have reported difficulties getting copies of their complete electronic files, the investigation found.

Consumers have long sought to be more in the loop on health care decisions in a user-friendly form. Many specifics about how that will happen, including how patients would make sense of complex pricing policies for purchasing health care and insurance and assessing quality, remain unclear, however.

To cut down on exorbitant “surprise” medical bills, Verma said, the CMS’ new rule would require insurers to let patients know which medical providers are in their networks. One study found that such bills — often not covered by insurance — have struck more than half of American adults.

For well over a decade, federal officials have struggled to set up a digital records network capable of sharing medical data and patient records. In 2004, President George W. Bush said he hoped to have a digital record for most Americans within five years. In early 2009, the Obama administration funneled some $36 billion in economic stimulus money to help doctors and hospitals buy the software needed to replace paper medical files.

Despite the slow progress, federal officials remain optimistic that digital records will save the nation billions of dollars while reducing medical errors, unnecessary medical testing and other waste — and encouraging more Americans to take a bigger role in managing their health care by comparing prices.

Trump administration officials on Monday sought to blame the Obama administration for creating what they called a “tower of Babylon,” in which doctors and health systems couldn’t seamlessly share patient information or “talk to one another.”

“It’s led to a tremendous amount of frustration on the part of medical professionals and patients as physicians, interacting with patients, oftentimes spend more time looking at computer screens than they do into the eyes of the people they’re trying to heal,” said White House official Joe Grogan.

New rules for digital charts

The Department of Health and Human Services on Monday issued two rules to give patients greater access to their electronic health records.

Among the key provisions:

  • Patients must be able to access their medical records on a smartphone at no cost and can share those records as they choose.
  • Health systems must be able to exchange information about patients’ past medical treatments or conditions.
  • “Information blocking” practices (that is, anti-competitive behaviors) by health care providers, developers of electronic medical records and others are prohibited.
  • Electronic medical record certification requirements are updated so that health professionals can discuss safety and usability concerns without being bound by gag clauses in software sales contracts.
  • Insurers are required to share health claim data with patients on Medicare and Medicaid through a mobile app.
  • Insurers must advise patients of their network of health providers through an app.

This article was first posted on Kaiser Health News. It also appeared on Fortune.

About the Authors

Fred Schulte is the John A. Hartford Senior Correspondent on the Kaiser Health News enterprise team.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Erika Fry is a senior writer at Fortune Magazine.

Appendicitis Is Painful — Add A $41,212 Surgery Bill To The Misery

As reported by the Kaiser Family Foundation

Joshua Bates knew something was seriously wrong. He had a high fever, could barely move and felt a sharp pain in his stomach every time he coughed.

The 28-year-old called his roommate, who rushed home that day in July 2018. The pair drove to the nearest emergency room, the Carolinas Medical Center in Charlotte, North Carolina. After several tests, including a CT scan of his abdomen, the emergency team determined Bates had acute appendicitis.

“They said my appendix was minutes away from rupturing,” Bates said.

Not mentioned, he said, was that the hospital was out-of-network with the insurance plan provided through his job. Even so, he couldn’t have jumped up and gone elsewhere. His appendix was about to burst.

He had surgery that night, which went smoothly, and went home the next day.

“Everything seemed according to plan,” said Bates.

Then the bill came.

Patient: Joshua Bates, a technical recruiter for a staffing firm, who lives in Charlotte, North Carolina. The Continental Benefits insurance plan comes with a deductible of $2,000 and an annual out-of-pocket maximum of $6,350.

Total Bill: $41,212 covering the surgery, one night at the hospital and the emergency room charges. After payments by both Bates and his insurer, the hospital sent Bates a bill for the balance, just over $28,000.

Service Provider: Carolinas Medical Center, owned by Atrium Health, a not-for-profit health system based in Charlotte.

What Gives: Bates was “balance billed” because he went to an out-of-network hospital — and, even though it was an emergency, he fell through the limited protections in existing law.

“Terrifying,” is how Bates describes the feeling when he first saw the bill for $28,000. Don’t worry, his insurer told him, it would negotiate with the hospital.

“If you pay your complete deductible, this will all go away,” Bates recalled the insurer saying. “I pay. It doesn’t get resolved.”

More than a year later, with negotiations between the hospital and his insurer at a standstill and his credit score falling because the $28,000 debt has gone to collections, a frustrated Bates contacted “Bill of the Month.”

“From what my insurance is telling me, the hospital is just non-responsive to them trying to negotiate this price,” he said.

His situation is not unusual. A recent study found that about 18% of emergency room visits have at least one such charge for out-of-network care.

A balance bill is the difference between what insurers pay toward a bill and a provider’s “list charges,” which facilities set themselves and often bear little or no relationship to actual costs.

In Bates’ case, the insurer paid $8,944 toward the $41,212 charges, according to his explanation of benefits from his insurer. On top of that, Bates paid the hospital about $4,000, a combination of his annual deductible and his coinsurance for emergency care. That left $28,295 of the hospital’s charges unpaid.

The online site Healthcare Bluebook, which calculates costs based on health insurers’ claims data, estimates a laparoscopic appendectomy ranges from $9,678 to more than $30,000 in Bates’ ZIP code. The “fair price” it suggests for the surgery is $12,090 — completely in the ballpark of the $12,944 that Bates and his insurer already paid the hospital. Fair Health, another site that collects claims data, estimates total costs for an out-of-network appendectomy at $19,292 — about $11,000 less than the hospital says Bates still owes.

“It’s ridiculous. He’s a young kid who goes to the emergency room and he has insurance,” said Duane Sunby, the insurance broker for Bates’ employer.

Sunby added that Continental’s payment to the hospital was nearly 2½ times more than Medicare would have paid for similar services, but the facility is going after Bates for more than seven times what the federal government would pay. A growing outcry about such balance bills has attracted attention from statehouses and Congress, but current protections for patients often fall short.

Congress last year debated several bills that would have provided federal protection nationwide, especially for emergency room patients. But bipartisan efforts stalled late in the year following intense lobbying by providers, including private equity-backed physician groups, over how to calculate what insurers should pay providers.

Bates is the kind of person who would be helped by a federal law, because his employer “self-funds” his insurance plan — all such plans are regulated by the federal government.

In the absence of federal rules, about 21 states have taken action, although a study from policy experts at Georgetown University Health Policy Institute cites only nine as having comprehensive protections.

North Carolina, where Bates lives, has partial protections for people in state-regulated plans, according to the study. It limits, for example, the amount patients owe in out-of-network emergency cases. But the state law doesn’t cover Bates’ type of job-based insurance.

“We really need a federal solution,” said Maanasa Kona, an assistant research professor at Center on Health Insurance Reforms at Georgetown.

Bates’ insurer brought in third-party Advanced Medical Pricing Solutions, which examined his bill and called the nearly $28,000 “excessive charges.” It sought in September an adjustment or an explanation of the charges.

That came not long after Bates received a “final” payment notice from a collections group connected with the hospital. A credit reporting agency “told me it would continue to impact my credit score,” said Bates.

Resolution: After KHN and NPR placed inquiries about his bill with the hospital, insurer and AMPS, Bates received a call from a top executive at the Carolinas Medical Center.

“He seemed really eager to help me out,” said Bates, “which is crazy after two years of reaching out and trying to communicate with them. They call shortly after they catch wind of the story.”

However, in an email to KHN, an Atrium Health spokesperson essentially pointed to the insurer for a solution.

“We believe it is imperative that insurance companies cover the costs for patients who are unable to choose where they are treated due to a medical emergency,” wrote Dan Fogleman. “We continue to be willing to work with this patient to pursue any additional payments that may be due to them from the insurer.” Continental Benefits CEO Betsy Knorr declined to comment: “It is a legal issue at this point and we do not want to prejudice the process.”

Bates is deflated.

“The hospital is trying to put all the burden on the insurance, and the insurance is trying to put the burden on them. I’m back to square one, essentially.”

The Takeaway: Insurance plans’ yearly out-of-pocket maximums apply only if you stay in-network. So, if possible, check ahead of time to see if your hospital is in-network — and the network status of anyone who might be involved with your care.

Sometimes that isn’t possible, as in Bates’ case. What then?

If you get a balance bill after your insurer has paid the provider, check state laws and with your state’s insurance regulators to see what protections you may have, said Kona, particularly if your bill resulted from an emergency room visit.

Ask your insurer or employer to pay the bill or to negotiate a discount with the provider, said Mark Hall, a law professor at Wake Forest University who studies contract law and medical billing issues.

Check online claims data websites, such as Healthcare Bluebook and Fair Health, to research what insurers pay for similar care in your area. Use that price range in negotiations about what you may owe.

Even if your employer plan is exempt from state laws limiting patient responsibility for out-of-network emergency care, ask the provider to honor that benefit. They don’t have to agree, but it can be worth a shot.

Hall also said patients may be able to hire a lawyer and go to court challenging whether the amount being charged is reasonable, although that could be costly and success is not guaranteed.

Loopholes Limit New California Law To Guard Against Lofty Air Ambulance Bills

This is a great example of a consumer in a healthcare prison.

Kathleen Hoechlin lost control as she crested a small jump on her final ski run of the day at California’s Mammoth Mountain two years ago. She landed hard on her back, crushing one of the vertebra in her lower spine “like a Cheerio,” she said.

An air ambulance flew Hoechlin, then 32, to an airport near Loma Linda University Medical Center in Southern California’s Inland Empire. There she underwent emergency 12-hour surgery to remove bone fragments and replace the crushed vertebra with a metal cage that was fused to the rest of her spine with rods and screws to provide structure and stability.

Hoechlin was still in intensive care when her husband, Matt, got the bill for the 300-mile air ambulance ride. The total: $97,269. The company wasn’t in their health plan’s network of providers, and the PPO plan they had through Matt’s job agreed to pay just $17,569.

The Hoechlins were on the hook for the $79,700 balance.

“It was just shocking,” said Hoechlin, who worked as a business analyst project manager in Highland, California. “I was just focused on, ‘Am I going to be able to walk again?’ I thought I was going to have a heart attack when he told me.”

A California law that took effect Jan. 1 aims to protect consumers from such enormous bills for out-of-network air ambulance services. The measure limits what consumers owe if they’re transported by an air ambulance that’s not part of their insurance network to the amount that they’d be charged if they used an in-network provider. The health plan and the air ambulance provider must then work out payment between themselves.

But the new law won’t protect consumers like Hoechlin, whose health plan isn’t regulated by the state. Matt’s employer pays its workers’ medical claims directly rather than buying state-regulated insurance, a common arrangement called “self-funding.” Self-funded plans are regulated by the federal government and generally not subject to state health insurance laws.

In this regard, the new air ambulance law is like laws in California and other states that protect consumers from surprise medical bills: They don’t apply to residents in federally regulated health plans. Those plans cover about two-thirds of people who get insurance through their jobs nationwide.

In California, that translates to nearly 6 million people.

Federal legislation is the best solution for those consumers, experts say. One of the leading bills before Congress to address surprise medical bills includes air ambulance charges. But that, and other measures, are up in the air, although members of Congress say they are working to reach an accord this year.

Another legal wrinkle affects even consumers with health plans the state does oversee. Under the federal Airline Deregulation Act of 1978, states aren’t permitted to regulate the “rates, routes, or services” of air carriers, including air ambulances. It’s unclear whether the California law, which doesn’t spell out a payment rate for a health plan, would be preempted by federal law if challenged in court, according to legal experts.

“It’s a very big step in balance billing, but it’s not a definitive one,” said Samuel Chang, a health policy researcher at the Source on Healthcare Price and Competition, a project of the University of California-Hastings.

Although people rarely need to be transported by a helicopter or airplane for medical care, it’s often an emergency when they do, and they’re unable to shop for an in-network provider, even if their health plan offers one. According to a federal Government Accountability Office analysis of air ambulance private insurance claims, 69% of air ambulance transports were out of network in 2017.

The median price charged in 2017 was $36,400 for a transport by helicopter and $40,600 by plane, according to the report. If an insurer doesn’t have a contract with an air ambulance provider, the air ambulance company may bill the consumer for whatever the insurer doesn’t pay, a practice known as balance billing.

“The air ambulance issue is such a big deal because it’s just such an eye-popping bill,” said Yasmin Peled, the policy and legislative advocate at Health Access California, a consumer advocacy group.

Air ambulance providers defend their charges, saying the rates offered by commercial insurance companies barely cover their costs. And public insurance programs often pay even less.

“Seven out of 10 of our transports are Medicare, Medicaid or uninsured,” said Doug Flanders, director of communications and government affairs at Air Methods, a large air ambulance company that provides services in 48 states, including California. Medicare pays Air Methods an average of $5,998 per transport, and Medicaid payments are typically half of that, Flanders said via email. That presents a “huge financial challenge,” he said.

In recent years, Air Methods has focused on joining the networks of some major insurers, including Blue Shield of California and Anthem Blue Cross of California, Flanders said. In addition to protecting patients, being in network “stabilizes operations and eases the administrative burden of the claims processing procedures created by insurers,” he said.

For the past several years, reimbursements by Medi-Cal, the state’s Medicaid program, for air ambulance services have been bolstered by funds collected from penalties for traffic violations. But the penalty was slated to sunset in 2020. Under the new California law, the state will extend supplemental funding of Medi-Cal payments for air ambulance services until 2022. Without that agreement, the rates would have reverted to much lower 1993 levels.

With the higher Medi-Cal rates, the industry supported the bill, including the prohibition on balance billing. In fact, the California Association of Air Medical Services sponsored the bill, although it didn’t respond to requests for comment.

In contrast, when other states have tried to prohibit air ambulance balance billing, the companies have often successfully challenged those laws on the grounds that the federal Airline Deregulation Act of 1978 prohibits state rate setting, according to Erin Fuse Brown, an associate law professor at Georgia State University who has studied air ambulance billing.

Legal experts say California’s approach may thread the needle where other states have failed.

“I do think the state has a pretty tolerable argument here that they are not regulating rates,” said Christen Linke Young, a fellow at the USC-Brookings Schaeffer Initiative for Health Policy. “They are telling the air ambulance providers who they can go to to get paid, but they’re ultimately not telling the amount that is getting paid.”

Kathleen Hoechlin and her husband, who now live in Riverside, California, eventually negotiated the amount they owed down to $20,000, arguing to the air ambulance firm that by tapping their savings and using money from a GoFundMe campaign, that was all they could afford.

She is now able to walk with only a slight limp. But she continues to deal with severe pain due to nerve damage. She recently underwent a fourth surgery to implant a spinal cord stimulator to interrupt the pain signal to her brain.

“When you look at the bigger picture, at the total amount, we’re feeling very fortunate,” she said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation. COPY HTML

Some elements may be removed from this article due to republishing restrictions. If you have questions about available photos or other content, please contact [email protected].

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