While this applies to Western North Carolinians specifically, I’d be very surprised if the same problems were limited to Mission Hospital, Asheville. I suppose it is possible that this only happened to one person ever in the history of Mission Hospital, too.*
Have a look instead at its long statement, especially page 2.
When you call Financial Services and are asked, “Do you want to pay off your account or set up a payment plan?”, answer, “Neither. I want to talk about how Mission Hospital, to comply with the provisions of Obamacare and the Federal IRS laws for retaining its status as a non-profit, must do these things”:
establish written financial assistance and emergency medical care policies,
limit amounts charged for emergency or other medically necessary care to individuals eligible for assistance under the hospital’s financial assistance policy,
make reasonable efforts to determine whether an individual is eligible for assistance under the hospital’s financial assistance policy before engaging in extraordinary collection actions against the individual, and
conduct a CHNA and adopt an implementation strategy at least once every three years. (These CHNA requirements are effective for tax years beginning after March 23, 2012).
Let’s talk in particular about 2 and 3.
Mission should provide at your request help with understanding its financial plan. If you’ve ever been in the ER, be it 3 am or 3 pm, a representative of the billing department is going to show up in your cubicle. But try, just try, to get to talk to a social worker. It won’t happen.
Number 2 won’t make sense to the person who has never had insurance. But if you do, you know your bill has two charges, the hospital’s charge and the negotiated charge. Now, in common only with the most exclusive restaurants, you have no idea what your bill is going to be when services are rendered. The hospital does not have to advertise its prices. Moreover, one price is charged to those without insurance; a negotiated price is charged to those with insurance.
Under the provisions of Obamacare, if you fall into the category of less than or up to 300% of Federal Poverty Guidelines, you must receive the “negotiated rate,” not the full rate
Number 3 is about collection agencies. It is a violation of the law to for a hospital to sell a bill to a collection agency if you ask to discuss if you qualify for financial assistance or during the approval process. They can’t just say, no insurance, don’t want to bother working with this guy, sell it on.
So what do you do if you make minimum wage or not far more? Get ready for battle. Use the magic words “report” and “IRS.”
I’ve always had a good health plan. But I am absolutely for single-payer. I see this as a classic example of, I’ve got mine, why should I care about yours? which is simply cruel. Failing that, while Obamacare is being “fixed,” the policies now in place must be enforced. What good it would do to fix Obamacare if right now, there are no penalties for hospitals that don’t comply? There are penalties for not having insurance, after all.
But, you may well ask, if you meet Federal Poverty Guidelines, don’t you get free medical care? Medicaid? Maybe in some states that accepted Medicaid expansion, a healthy male in his 20s could. Not in NC, where basically two categories qualify : pregnant and elderly who have no money besides $3500, $1500 of which is designated for body disposal.
But what about the healthcare exchanges so that everyone can afford healthcare? Don’t you get a tax penalty if you don’t have insurance? The answer to the second is yes. But look at the policies you can buy in the exchanges. Then do some math. The minimum wage in NC is $7.25, so if you work 40 hours a week, before any deductions, any taxes, in 40 hours you make $290.00. But here’s the thing, if you work minimum wage, you are far more likely to work 39 hours a week so you are not full time.
So let’s pretend you take home $1000 a month. Average price for a studio apartment in the City is $650. So, presto,down to $35, or $35 a day for transportation, food, utilities, and so on.
So what do people do? If they ever, ever want to get a car loan or credit card, they set up a payment plan, and take on another job. Move into a shared space. Hope they don’t get sick or have an accident. Pay the fine, which means not getting a part of the money from their tax returns that is the one time of year when they have a little extra to do things like buy tires, fix the roof, or –maybe if it is big enough –see a dentist. Or at least an optometrist.
Next time I will discuss the barriers to the poor getting what they are supposed to get.
*This is my legal disclaimer since Mission has deep pockets. I can and would be glad to swear and provide documentation for one case. Under this heading.
**2017 FPG for 1 person was $12,060. 300% was $36,180. In 2016, the numbers were $11,880 and $35,640. What, did everyone get a raise on January 1, 2017? Guess some places didn’t get that memo.