Transplant patient’s nightmares illustrate why patients fear and loathe medical bills

billssurprisefearof-300x228It may be bad for the blood pressure. But to understand a key reason why Americans seethe when talking about medical bills and medical costs, just start perusing a timely new magazine report on hospitals and debt collection.

The Atlantic article — “What Happens When You Don’t Pay a Hospital Bill” — details the horrors and frustrations experienced by Joclyn Krevat, an occupational therapist in New York. She sought medical care for what she thought was a nasty case of flu. She, instead, suffered from a severe heart inflammation — and ended up undergoing a costly and physically draining heart transplant.

Weak, sick, and on the brink, Krevat still was hounded by out-of-control debt collectors — cruel men and women who not only lack hearts of their own but who engage in relentless, often ridiculous tactics (like trying to connect on social media, just to harp on patients there about their bills) to wring pennies out of those with illness and injury, reported writer Olga Khazan.

While Khazan walks through Krevat’s case to illustrate the scandal of medical debt collection, she also reported that:

“About 43 million Americans have unpaid medical debt dinging their credit, and half of all overdue debt on Americans’ credit reports is from medical expenses, according to a Consumer Financial Protection Bureau study from 2014. The debt typically comes from out-of-network doctors who people thought were in-network, hospital stays, or ambulance rides. About one in six Americans received a surprise out-of-network medical bill in 2017 after being treated in a hospital, even though they had insurance, according to Kaiser Health News.”

As Krevat’s circumstances bear out, Khazan also reported, medical debt fast turns into a never-ending nightmare, no matter patients’ concerted efforts to reach out and try to be reasonable and recovering members of the workforce. As she wrote:

“Companies can try to collect on medical debt virtually forever. Although old debt is easier to escape in court, little prevents debt collectors from trying to collect on it. ‘Debt never dies,’ says Craig Antico, a former medical-debt collector and a co-founder of RIP Medical Debt, an organization that buys and eliminates medical debt. Only Wisconsin, North Carolina, and Mississippi clear certain debts once they are past the statute of limitations. Generally, hospitals seeking to get bills paid place accounts in a ‘waterfall’ of collection attempts, Antico told me. At first, hospitals, or the collections agencies they hire, will approach debtors with a ‘soft’ collection: Did you misplace your bill? Maybe you qualify for charity care. ‘But then if people aren’t responding, it will get more stressful,’ Antico said. A collection agency might report the amount owed to a credit bureau, or the account might be sent to an attorney to enforce collection. (A new proposed federal rule would prohibit debt collectors from calling more than seven times weekly about a debt, but consumer advocates told me this could still result in more than seven calls in a week, since each doctor’s bill can count as a separate debt.) Eventually, collectors might opt to sue you, in which case they might be able to garnish your wages or put a lien on your property. Antico estimates, based on an ADP report, that about 1.5% of American employees have a garnishment on their wages for a medical reason.”

The finance-focused U.S. economy also has created yet another torment for those with medical debt: error-ridden secondary markets. Hospitals and other medical providers turn to these, bundling past-due accounts and selling them to companies for pennies on the dollar. These debt buyers not only keep pursuing patients for sums owed, they often cannot be dissuaded that medical obligations have been covered, or that a patient may be targeted in total error.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of therapies and especially of prescription medications, too many of which prove to be dangerous drugs.

Although the overzealous collections are one of health care’s shames, doctors, hospitals, ambulance services, and others are driving a lobbying shiv into federal efforts to help consumers with “surprise medical bills.” Modern Healthcare, an industry media monitor, says that dark money groups, doctors, and others are pouring millions of dollars into campaigns to derail congressional efforts to help patients who discover they must pay huge charges because they received services from medical providers who are not covered in their health insurers’ “narrow networks.”

As Khazan points out, a significant problem with consumers’ medical debt is that is incurred when they have little or no say about it. They can’t leap up from gurneys in the emergency room to question every individual who approaches in a white jacket and with potential billable time. They can’t argue whether they can afford a lifesaving helicopter or airplane flight to the nearest trauma center. They’re not going to rip the mask off their face in the operating suite to ask if the anesthesiologist is one of their “in network” specialists.

In the meantime, all of us is a major injury or illness away from financial catastrophe — and this includes workers and their loved ones who may have what consider to be good coverage on the job from an employer, or say, an employee group like a union. The New York Times reported how jaw-dropping prices for specialized prescription medications, drugs that may be life changing for individuals with rare diseases, can stagger even the most responsible and seemingly fiscally solid health plan at a company or union. The newspaper found Buckeye boilermakers who wanted to do the right thing for a union member’s wife. But how could they afford the lifetime tab for her care — $60 million to spare her debilitation and pain.

That also meant, however, that “At one point in 2018, for every hour that one of the union’s 16,000 members worked, 35 cents of his or her pay went” to cover the cost of one family’s drugs for a rare disease. By the way, that’s a misnomer, as the New York Times reported, because there are 7,000 “rare” diseases and 30-million Americans suffer from them.

Sure, it’s great that medical science has advanced the treatment for illnesses and injuries. But, at the same time, if medical care, medical bills, medical debt, and medical bankruptcy destroy patients finances and their lives in money terms, what kind of robbing of Peter to pay Paul can Americans continue to accept? We’ve got a long way to go to ensure that health care is a right — and affordable one — and not a privilege of the wealthiest few. Regulators also need to step up so that usurious debt hounds get relegated to where Dante, the great Italian poet, suggested they should be — in a deep, dark level of perdition.

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