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Advocates, lawmakers push hospitals to help more with bills

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

Medical bills often represent large, 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 COVID-19 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,” Gundling 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.

Benjamin said she once helped a patient who had one kidney stone removed and received 28 bills.

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.

“People never read the whole bill. They’re scary and overwhelming,” said Benjamin, who would like to see hospitals include a one-page financial aid form with their bills.

Other advocates say information about financial assistance should be included on paper that’s a different color and more noticeable. They also want hospitals to check back in with patients to see if they need help once a bill becomes overdue.

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