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Hospitals’ aid info can be hard to find

Executive says officials fear patients will shop for the biggest discount

Charity policies vary by hospital health bill: Did you pay extra?

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By Jim DeBrosse, Staff Writer Updated 12:04 AM Sunday, April 19, 2009

In the outpatient waiting area of Kettering Memorial Hospital, you’ll find plenty of marketing and promotional signage and a nearly life-size oil painting of a little girl handing her sub sandwich to a homeless man lying on the sidewalk.

What you won’t find there is a sign informing patients and their families that the hospital is required to provide free care to families earning up to the federal poverty level. Nor will you find that sign posted in the hospital’s registration office or its emergency room area, as required by state law.

“I don’t know what happened to those signs, but I do know that anyone who qualifies (for financial assistance), we’re going to find that out and make sure they get the appropriate discount,” said Kettering Health Network spokesman Kevin Lavoie.

The Kettering Health Network provides some aid for all patients earning up to three times the poverty standard, and is the only area hospital that caps a hard-pressed family’s monthly payment at 10 percent of household income. Kettering officials also point out that all bills from the hospital include notices that financial assistance is available to those who qualify.

Most hospitals aren’t keen on making financial assistance policies known, and there’s a very practical reason, said Bryan Bucklew, executive director of the Greater Dayton Area Hospital Association.

“The concern is that people will shop around (and find) where they’ll have to pay the least amount for their care,” Bucklew said. That could put some hospitals already serving more than their share of uninsured and underinsured patients into financial jeopardy, he said.

Bucklew said the association is working with area hospitals to arrive at community-wide financial assistance guidelines that are fair to all hospitals. He admitted hospitals also need to do a better job of “taking the mystery out of those policies” for patients and their families who need help.

State law mandates that all hospitals receiving Hospital Care Assurance Program funds provide free care to patients who earn up to the federal poverty level. Beyond that basic level of help, it’s up to individual hospitals to decide how far they will go to assist needy families.

Tiffany Himmelreich, a spokeswoman for the Ohio Hospital Association, said that’s the way it should be: “Every hospital has a different patient mix (of insured and uninsured patients) and a different set of financial circumstances. For instance, you can’t expect a small rural hospital to provide the same charity care as a large urban one.”

Hospitals in the Premier Health Partners and Community Mercy Health Partners networks provide aid to families earning up to four times the poverty level. Wayne Hospital in Greenville and Wilson Memorial Hospital in Sidney cut off theirs at just twice the poverty guide.

The poverty line varies depending on family size. For example, it’s $10,210 for an individual and $20,650 for a married couple with two children.

Some hospitals apply their charitable discounts to the hospital’s estimated costs or its negotiated rates with insurers. Others apply them to their full charges, which can run considerably higher than a hospital’s actual costs. Hospitals also vary in their debt collection practices and when they will turn a delinquent account over to a collection agency.

Short of contacting the chief financial officer at every hospital, patients will be hard-pressed to find hospital employees who can explain exactly what their charity care policies are. Most media relations officers at local hospitals contacted by the Dayton Daily News needed days or even weeks to find the right person to answer a short list of financial aid questions.

Children’s Medical Center initially refused a reporter’s request for details of its financial aid and debt collection practices, saying those were “an internal policy” not to be shared with the public. The hospital later provided full information.

“It just shows you the lack of institutional commitment to financial aid at most hospitals in Ohio,” said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio. The Columbus-based consumer advocacy group has spent years pressing state officials to enact tougher standards for charity care as the economy worsens and health coverage dwindles.

More than 1 million Ohioans — 11 percent of residents under age 65 — now lack health insurance, according to a recent survey by Policy Matters Ohio, a left-leaning think tank based in Cleveland. As deductibles and co-pays climb, one in four insured Ohioans (23.5 percent) is having difficulty paying medical bills, the survey found.

Among the uninsured, even those who earn two to three times the poverty level “can afford to contribute little, if anything, toward health care without sacrificing other basic needs,” the study concluded.

Nine states now mandate free hospital care for anyone who can’t afford to pay, according to Community Catalyst Inc., a patients’ advocacy group based in Boston. Six other states limit total hospital charges to a percentage of family income. Ohio does neither.

Levine said the job of overseeing hospital charity care policies begins with Attorney General Richard Cordray, whose office is responsible for regulating nonprofit institutions and protecting the rights of patients. Most hospitals in Ohio, and all of them in the Dayton area, are nonprofits required to provide charity care of some kind as part of their tax-exempt status.

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