Clinton woman, buried by bills, is pursued by hospitals

Overwhelmed by bills, Clinton woman is pursued by hospitals

jneff@newsobserver.com April 22, 2012 

  • More information About the reporting  Reporters from The News & Observer and The Charlotte Observer conducted scores of interviews with patients, hospital administrators, health care experts and others. They also examined thousands of pages of documents, including lawsuits, financial audits and hospital bills, as well as Medicare cost reports, IRS returns and community benefit reports filed by hospitals.  Profit figures for Triangle hospital systems come from their audited statements. These statements combine the finances of the hospitals within a system, the doctors’ practice groups and other entities. The systems’ results differ from the results of the individual hospitals.  Figures used with the map on newsobserver.com for the profit margins of individual hospitals are different. They come from the American Hospital Directory, a service that compiles financial data for thousands of hospitals nationwide. AHD’s profit figures are derived from data in Medicare cost reports, which hospitals are required to file each year with federal health officials.  Our stories use total profit margins, which include investment income. Some hospital officials objected to the use of total profit margins; a better measure, they argue, is operating margin, which excludes investment income and reflects the profits from patient-care activities.  Other experts, however, contend the total margin provides more insight into a hospital’s full financial picture. Investment income is meaningful, they say, because the money that hospitals invest comes largely from past profits.  Both total and operating margins are listed in an online tool that allows readers to look up key information for every North Carolina hospital.

— Mary Jo Warren has been swamped by hospital bills since she suffered a stroke nearly two years ago.

Unable to work, she lost her nursing home job – and her employer-sponsored health insurance. She’s been to Sampson Regional Medical Center many times since her stroke for high blood pressure, congestive heart disease and bones broken in her frequent falls.

Warren is not eligible for Medicaid, the government health insurance for the poor. At 63, she’s too young for Medicare. And she is bewildered by the flood of bills that now total $8,400, the applications to get financial help and the letters from collection agencies and law firms demanding that she pay up.

Since her stroke, Warren has lived on a Social Security widow’s benefit of $1,211 a month, 133 percent of the federal poverty level. Under the hospital’s financial assistance policy, uninsured patients earning less than 125 percent of the poverty level can qualify for free care. Sampson Regional accepted her application and cut 45 percent off the balance that she owed.

Her insurance had covered some of her care before the policy expired.

Two months later, a lawyer representing the hospital wrote Warren two letters demanding payment of $1,049.93 and threatening a lawsuit.

Warren said she feels constantly on the edge of tears when she talks about her bills.

“I’m not trying to be a poormouth, but my God, what can I do?” she asked.

Her debt was even deeper. After her stroke, doctors sent her in an ambulance to WakeMed in Raleigh. Her health insurance covered much of that bill, but Warren has struggled to pay the balance of nearly $1,500 to the hospital, ambulance service and two doctors’ practices.

She went to a neurologist at UNC Hospitals, where her balance stood at about $800. Warren said she felt overwhelmed by the applications for charity care, so she didn’t complete them.

Both hospitals referred her to collection agencies.

On a recent trip to Sampson Regional, Warren was billed $200 for a mammogram. At the urging of the hospital, she signed up for a medical credit card from Access One, a medical credit card company.

Warren’s sister had purchased an insurance policy with a high deductible. The policy paid nothing on the mammogram.

Stuck with an undiscounted bill, Warren wasn’t able to pay. Within a few months, finance charges and late fees had pushed her balance to $237.59.

Another chance for help?

Sampson Regional spends less than $250,000 a year on charity care – less than 1 percent of its budget. Its charity care policy is among the state’s least generous.

But many of its patients, like Warren, need all the financial help they can get. The hospital serves a rural Eastern North Carolina community where one in five residents lives in poverty.

Hospital officials say they’ve been working to get the word out about charity care – and to get more patients qualified.

But many patients have not cooperated by applying, says Jerry Heinzman, the hospital’s chief financial officer. Some simply don’t care because they don’t intend to pay and already have poor credit ratings, he said.

After being contacted by a reporter, Heinzman said he has asked Warren to apply again for more financial assistance. He knew nothing about her inability to work.

“If you weren’t doing a story,” he said, “I wouldn’t have known she had a stroke.”

Up until the time her health took a turn for the worse, Warren said she was frugal, hardworking and self-reliant. Now she frets about not being able to pay her hospital bills. After her rent and utility bills, she has just $131 left each month to spend on food, prescriptions and toiletries. She collects monthly sacks of groceries from a food pantry in Clinton and two local churches.

Warren, a high school graduate, said she struggles with the mess of bills on her table. She said she is gathering her tax returns and receipts for UNC and WakeMed to apply for charity care.

Still, calls from hospitals and collection agencies come almost daily, rattling her nerves. One call came during a 90-minute interview at her house.

“They say, ‘Ms. Warren, we expect you to pay us money,’ ” she said. “I say, ‘I ain’t got any.’ And they say, ‘Well, that’s no excuse.’ ”

Warren fears the stress may trigger another stroke. But fearing more bills, she has been reluctant to seek additional medical treatment. So she now waits until she is “really desperate to get some help.”

And that, she knows, can’t be good for her health.

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