Tuesday, May 01, 2012

Pay Or Die

We are at our most vulnerable when we are sick or in pain or afraid of dying. Somebody decided this was a good moment to demand payment up front. Pay or continue hurting. Pay or die. Health problems already put our lives and our finances in jeopardy. It's sick to hit up the vulnerable for money prior to helping them. It seems a lot like extortion to me. Demanding money with menaces. You'll read in these reports from the Minnesota Attorney General (reported in the StarTribune) that they also threatened the sick with harm to their credit rating. In company emails they mocked the poor who needed help and bragged about turning the screws on them. Fairview Hospitals, founded to help Minneapolis's poor and sick Norwegians, is the hospital system where these egregious practices were in effect. The aggressive bill collection firm is Accretive, from Chicago.

"Marcia Newton of Corcoran was one consumer who saw Accretive's tactics firsthand. Although she is fully insured by Blue Cross and Blue Shield of Minnesota, she says she was told by a Fairview admissions clerk that she needed to pay $876 upfront as her share of a $9,000 procedure to insert tubes in the ears of her 3-year-old son. But when Newton received her insurance statement, she learned that the procedure cost $4,200 and her share should have been $200."

She says she spent two months fighting with Fairview after her credit card was overcharged by nearly $700.

"If I hadn't read that explanation of benefits from my insurer, I would have thought I paid my money and was done," said Newton, a certified public accountant with an MBA. "A lot of people who couldn't have afforded it would have gotten ripped off."

Patients arriving in Fairview emergency rooms with serious conditions and in pain were subjected to strong-arm collectors and pressured to pay before being helped.

Internal e-mail from a collector at Accretive's Kalamazoo, Mich., office "I make the deadbeats feel like s---, talk nicely to women who sound education/have money, and am firm with dumb f----. If they say something stupid, I make sure they know they've said something stupid."

Another collector's response to the above message "Thanks. I went through the hospital notes and this is what pisses me off the most. The patient is pissed because Medicaid didn't cover this and told the hospital that she is never going to pay this. There are some attorneys who aren't skilled enough for an actual practice that work for these stupid fricken non-profit organizations who help the poor in Detroit. Now we have to waste our time to deal with this low-life patient and some dumbass attorney all because this patient didn't show up to the DHS office to renew her benefits. Ugh. I'll make sure they get a call though."

A collector's response (the same day as the earlier messages) after learning a lawyer had left a message on behalf of a particular patient "Mrs Smith, my name is ______ and I'm the Financial Counselor (Admitting Rep) at [Fairview]. According to your insurance company you have a deductible of $100 and a 10% co-insurance. Based on a 3-day stay, your estimated amount due is $440. How would you like to pay for that today? We accept cash, check, debit or credit card."

Pay up front or you won't get treated, was the message patients got from Fairview:

One story, related by a physician who deplored the collections practices: "...a breast-cancer survivor was ushered into a small room with a billing officer who told her she had some unpaid bills to pay. She said, 'What bills? I have paid all my bills." The man told her she hadn't received the bills yet, but still had to pay them. When she refused, the man pleaded that it would look bad on his record..."

The NYTimes also covered the story.

There was an strange and absurd defense of Pay or Die from the Strib's "conservative" opinion writer Doug Tice, suggesting we should be forced to pay for emergency care up front like we do fast food...

And a thoughtful humane counterpoint by Paul Olson, also in the StarTribune.

This story points up the difficulties of hospitals and doctors, locked in a system of private insurers in an economy where patients increasingly cannot afford insurance. The best answer is universal healthcare via single payer, a government solution like Medicare, which is cost-efficient and beloved. Let the doctors treat their patients and let the patients get the help they need without worrying about finances on top of ill health.

But Republicans demanded a private insurance solution. Obama passed his Affordable Care Act with their input, chiefly the inclusion of an insurance mandate, something the ultra conservative Heritage Foundation proposed in 1989. But once ACA reached the floor of the Congress every Republican voted no, repeatedly. And now it is this Republican demand, the mandate, (which isn't some Communist invention––George Washington insisted on a health insurance mandate for merchant seamen when he was president) which the Republican court challenge is using to scupper the whole reform. And a return to financial and healthcare peril for anyone who has the bad luck to get sick.


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