For some, medical debt just keeps piling up

Hospitals urged to do more to help patients with bills

Swamped with medical bills? The hospital that treated you may be able to help.

Whether you learn about this before those bills wind up in debt collections is another matter.

Medical bills often represent unexpected shocks that can crash personal budgets. Roughly 1 in 7 U.S. residents with a credit record has medical debt in collections, according to the nonprofit Urban Institute.

Hospitals have ways to keep more people from joining those ranks. Those can include income-based discounts, payment plans, help finding health insurance or waiving a bill and writing it off as charity care.

But people frequently miss notices in their bills about assistance or have trouble plowing through the paperwork to qualify, patient counselors say. They say hospitals need to do more to ensure patients know about available help.

“We need a whole new mindset,” said Elisabeth Benjamin, a vice president with the nonprofit Community Service Society of New York. “A hospital’s a charity ... (it) should be figuring out why a patient isn’t able to pay a bill.”

The Affordable Care Act requires nonprofit hospitals to tell patients about financial help, but it leaves the details for how that gets done or the extent of the assistance largely up to them. Patient counselors see little consistency.

Hospitals say they often notify patients several times about available help. They’ve also eased income limits for assistance during the pandemic, and some have smoothed out cumbersome applications.

But it can be hard to identify everyone who needs help, said Rick Gundling, a senior vice president with the Healthcare Financial Management Association, which consults with hospitals.

“I think many times when the patient doesn’t have the money, they retreat or they don’t ask for help, when the hospital can help,” he said.

Assisting people in the middle of a medical crisis can be difficult. Patients often have no idea when they receive care what it will ultimately cost and how much help they will need. A slew of insurance notices and bills that arrive later can sow more confusion.

Hospitals frequently post notices about financial help on emergency rooms walls or in bills sent to patient homes. But those can be overlooked or forgotten.

Hospitals often post information about available help online. But that can be hard to find too.

Some hospitals — and state lawmakers — are trying to make improvements.

Oregon Health & Science University slimmed its application for help a couple years ago. When someone requests help paying for emergency or medically necessary care, the Portland academic health center now just asks for patient income, which it verifies with a soft credit check. That replaced a paper application that required several documents.

“We’re not here to have people worry about their medical bills,” said Kristi Cushman, the center’s director of patient access services.

Several states have laws that require hospitals to offer a range of free or discounted care, usually based on income, according to the National Consumer Law Center.

A new Maryland law requires hospitals to show that they provided information on financial assistance and made a good-faith effort to set up a payment plan before they sue over a medical debt.

That makes the hospital prove it has done all it can to make patient payments affordable, said Marceline White, executive director of the Maryland Consumer Rights Coalition. “It shifts the burden appropriately to the hospital, the multimillion-dollar entity, as opposed to the person making $40,000,” she said.

No such burdens have shifted in Tennessee, where Debra Smith worries she may be denied future medical care because of her bills.

Smith figures she has over $10,000 in unpaid medical bills from hospital stays over the past year, even though she has coverage through Medicare. She hasn’t been able to make much progress paying them off.

Smith, 57, sought help from Williamson Medical Center in Franklin earlier this year for a $1,500 bill, but they couldn’t settle on a payment plan.

Health problems prevent Smith from working. Living expenses and prescriptions consume most of the $2,300 a month she gets from a pension and Social Security.

She found the hospital’s application for financial help online, but she never completed it. That form asks for copies of bank statements, utility and credit card bills, car payments and other paperwork. To Smith, it felt like they wanted reasons to reject her.

Medical center spokesman Mike Alday said the medical center has to confirm a patient’s financial need before providing help. He said the medical center makes financial counselors available and offers discounts and payment plans if patients don’t complete financial aid applications.