Amid massive hospital sell-off, corporate giant continues suing patients(npr.org)
npr.org
Amid massive hospital sell-off, corporate giant continues suing patients
https://www.npr.org/sections/health-shots/2021/07/26/1019916638/amid-massive-hospital-sell-off-corporate-giant-continues-suing-patients
58 comments
I reread this twice, but I am still not sure how this helps the insurance company through. Is there something I missed? Or is this intend to cause administrative issues for out-of-network medical groups?
It puts the insurance company in the driver's seat when it comes to negotiations, and it severely hampers the administrative side of medical practice performing the services, because they are in the awkward position of having to sue a patient, or put liens/garnishments against a patient's income/house. Insurance companies may not be at all helpful in this process either.
i used the work in the substance abuse treatment space, where it's even more impactful. People with addictions go to treatment for 30-45 days, and when they get home, they have a $30k check to pay for the treatment. Same deal - insurance pays the individual who pays the center.
But I could not imagine a worse recipient, in terms of responsibility, than a recently recovered addict.
But I could not imagine a worse recipient, in terms of responsibility, than a recently recovered addict.
Why would a substance abuse treatment provider agree to treat a customer if their insurance company will not pay the provider directly?
Because they generally get their money, and because that's kinda how insurance works. It also may not have been obvious which situation would arise when they did the admission. Additionally, many places charge $5-10k directly and then bill insurance to the max they can - even if they can't always collect the check sent to the patient, it's still profitable. (IIRC, cost to admit a patient was $7-11k/month at the facilities we saw.)
It still does not make any sense to me that a business would continue engaging with another business that is causing them to lose money. If a business is getting ripped off, then they need to ask for cash up front, or have contracts requiring direct payment.
But if they are going to continue willingly engaging with a party that jerks them around, I do not see who they have to blame but themselves.
But if they are going to continue willingly engaging with a party that jerks them around, I do not see who they have to blame but themselves.
To be clear, I'm not suggesting the facilities are getting ripped off. In reddit terms, Everyone Sucks Here. Facilities use every shady tactic to get people in the door, so nobody should shed a tear for them.
My overall answer is that companies that bill insurance live in a complex world. Insurance tries to dodge payouts and will pay the insured; the facilities try to jam billing.
Perhaps an anecdote will be representative: I worked for one of the biggest providers, with dozens of facilities. They had a call center whose job it was to get insurance to approve another 3 days of treatment (30 day stay = 10 of these calls). Insurance companies don't staff their end, so the call centers were paying people to wait on the line for several hours, just to get treatment approved. (I ended up building a Twilio integration to queue up without a person on the phone.)
This is just a shitty, awful area of medicine and business and insurance.
My overall answer is that companies that bill insurance live in a complex world. Insurance tries to dodge payouts and will pay the insured; the facilities try to jam billing.
Perhaps an anecdote will be representative: I worked for one of the biggest providers, with dozens of facilities. They had a call center whose job it was to get insurance to approve another 3 days of treatment (30 day stay = 10 of these calls). Insurance companies don't staff their end, so the call centers were paying people to wait on the line for several hours, just to get treatment approved. (I ended up building a Twilio integration to queue up without a person on the phone.)
This is just a shitty, awful area of medicine and business and insurance.
That is embarrassing in a developed society.
> When her summons arrived, panic set in for Cantwell.
"My mind went immediately to the stimulus payments," she says. "At least I have a way to take care of this now."
FFS. Zero chance this was a coïncidence.
"My mind went immediately to the stimulus payments," she says. "At least I have a way to take care of this now."
FFS. Zero chance this was a coïncidence.
I don't understand your assertion. Were stimulus payments instituted to indirectly pay the companies that own hospitals? Will any further stimulus payments be issued with the same motivation?
> Were stimulus payments instituted to indirectly pay the companies that own hospitals?
No. But someone noticed stimulus payments were coming, looked up the debtors who owed amounts close to the stimulus amount and sent off aides to harass those people into turning over the money.
No. But someone noticed stimulus payments were coming, looked up the debtors who owed amounts close to the stimulus amount and sent off aides to harass those people into turning over the money.
This is exactly what happened, due to a deficiency in statute.
> Under the bill governing the second stimulus check, your funds could not be garnished to pay debts like child support, banks or private creditors. However, part of this rule changed with the third check.
> The bill authorizing the third payout was pushed through using a process called budget reconciliation. Congressional Democrats used this legislative tool to more quickly pass the new COVID-19 relief bill and the third stimulus check that comes with it, since it allowed them to pass it with fewer votes. But because this process was used, the third checks aren't protected from all garnishment, although lawmakers are moving to fix this now.
https://www.cnet.com/personal-finance/your-third-stimulus-ch...
> Under the bill governing the second stimulus check, your funds could not be garnished to pay debts like child support, banks or private creditors. However, part of this rule changed with the third check.
> The bill authorizing the third payout was pushed through using a process called budget reconciliation. Congressional Democrats used this legislative tool to more quickly pass the new COVID-19 relief bill and the third stimulus check that comes with it, since it allowed them to pass it with fewer votes. But because this process was used, the third checks aren't protected from all garnishment, although lawmakers are moving to fix this now.
https://www.cnet.com/personal-finance/your-third-stimulus-ch...
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The article makes no mention of the legal justification backing up any of these debts. They aren't due to straightforward contracts like nearly every other bill, as that would require up-front rates. And so they must be due to some state law that empowers hospitals to create arbitrary post-facto charges for whatever amounts they feel like. Part of the focus of healthcare reform needs to be on these state laws that enable the arbitrary billing racket in the first place - if they were eliminated, much of the opaqueness of the healthcare industry would be forced to change.
Sohcahtoa82(6)
> But lawsuits are a rich man's game. She couldn't justify trying to find an attorney or fighting a big, publicly traded company that would pursue her for $2,700.
This makes no sense and calls into question whether the article is being honest in its description of the debt in question. No superior court would waste its time over $2,700 - that's small claims territory, eg. no lawyers or fees for defendants.
In general if you owe a debt to a company that gets acquired the debt doesn't just disappear. A bunch of fluff about the pandemic doesn't change that either. So my take is that the lede is disingenuous and the piece smells like agenda-pushing.
This makes no sense and calls into question whether the article is being honest in its description of the debt in question. No superior court would waste its time over $2,700 - that's small claims territory, eg. no lawyers or fees for defendants.
In general if you owe a debt to a company that gets acquired the debt doesn't just disappear. A bunch of fluff about the pandemic doesn't change that either. So my take is that the lede is disingenuous and the piece smells like agenda-pushing.
The court doesn't waste it's time; the company does.
Furthermore, these sorts of bulk lawsuits can be used as scare tactics to scare up settlements. Obviously, prosecuting a lawsuit over a $2,700 debt makes no financial sense if you were to carry the lawsuit to completion. But it also makes no sense to defend against. Just settle. The vast majority of people do this and thus you can get lots of money by suing people this way.
Indeed, they basically outright stated this:
"As of January, the company has decided to take patients to court only if they make at least twice the federal poverty level — or about $52,000 annually for a family of four."
In other words, they target people who are most likely to settle and pay up.
(Bonus points: this is intended to sound exonerating, until you realize that there is no such thing as a "federal poverty level". $52,000 is dirt poor in New York City or San Francisco.)
Furthermore, these sorts of bulk lawsuits can be used as scare tactics to scare up settlements. Obviously, prosecuting a lawsuit over a $2,700 debt makes no financial sense if you were to carry the lawsuit to completion. But it also makes no sense to defend against. Just settle. The vast majority of people do this and thus you can get lots of money by suing people this way.
Indeed, they basically outright stated this:
"As of January, the company has decided to take patients to court only if they make at least twice the federal poverty level — or about $52,000 annually for a family of four."
In other words, they target people who are most likely to settle and pay up.
(Bonus points: this is intended to sound exonerating, until you realize that there is no such thing as a "federal poverty level". $52,000 is dirt poor in New York City or San Francisco.)
>In other words, they target people who are most likely to settle and pay up.
Seems like they can't win. If they sue everyone then they're called out for "suing the poor" or whatever. If they sue only people above an arbitrary cut-off then they're called out for "target[ing] people who are most likely to settle and pay up".
Seems like they can't win. If they sue everyone then they're called out for "suing the poor" or whatever. If they sue only people above an arbitrary cut-off then they're called out for "target[ing] people who are most likely to settle and pay up".
> this is intended to sound exonerating, until you realize that there is no such thing as a "federal poverty level".
https://aspe.hhs.gov/topics/poverty-economic-mobility/povert...
https://aspe.hhs.gov/topics/poverty-economic-mobility/povert...
Who's going to take the time out to explain that to a defendant? Certainly not the people trying to sue.
If you get served with a small claims lawsuit it is clearly labeled as such. And most small claims jurisdictions have no-cost mediation options to help people understand wtf is going on.
The threat of a lawsuit is not a lawsuit, it is instead a demand letter that will state that if you do not pay, you will be sued. It will not say in sued in small claims, it just says you will be sued.
So you would not get served to appear at a small claims court office, you will instead get a very scary letter on a law office's letter head, and you will pay the money.
So you would not get served to appear at a small claims court office, you will instead get a very scary letter on a law office's letter head, and you will pay the money.
You know this, as do I. You are assuming everyone else knows it too, and knows enough to say 'eat my shorts, file a small claim or GTFO.'
It's not the job of journalists to educate folk in this position, though a good journalist would point out such relevant facts to assist readers of the article who might be in a similar position nor or later. The primary job of the journalist is to report on the situation of their story subject, which might include a lack of financial or legal literacy.
It's not the job of journalists to educate folk in this position, though a good journalist would point out such relevant facts to assist readers of the article who might be in a similar position nor or later. The primary job of the journalist is to report on the situation of their story subject, which might include a lack of financial or legal literacy.
In my state and I assume many others the plaintiff can choose whether to file in small claims or the normal general district court. The defendant can file to have a case moved from small claims to general district but not the other way around. Judges also do not have the ability to move a case from small claims to the normal general district process unless the parties agree. Companies therefore usually file using the normal general district process in other to achieve the very result documented in this article.
I don’t think that’s correct.
https://www.columbiadailyherald.com/news/20191121/medical-de...
https://www.columbiadailyherald.com/news/20191121/medical-de...
They file suit hoping to get a no show default judgement, and then file to garnish either wages or bank accounts. Most don’t contest so it’s only filing fees on the plaintiff
The large insurer will send checks for goods & services directly to the patient, rather than to the practice(s) that performed the service, even if this is a fairly reasonable cost.
Patients see a check for $8,000 and $25,000 that is supposed to go to the trauma surgeon's practice that initially stabilized the patient, followed by the Plastic Surgeon's practice that spent 16 hours, 2 titanium plates, and a large number of titanium screws, and biologic implants reconstructing the patient's face. And, similar for the small consults $300 consults to Opthamology and Neurology that are common to severe head trauma involving optic nerves, relatively minor brain injures and significant facial trauma.
Instead of providing it to the practice to pay for the plates/screws, and delivered services, the patient spends the money. Then the patient gets sued.
This is not uncommon unfortunately - even for medical practices that TRY to be in-network with every single insurer, AND medicare/medicaid.