We saved your life but you may be financially ruined now.

February 19, 2010 5:00 AM

A dear friend had emergency heart surgery last week. He did not have insurance. Does the hospital just bill him the full amount and wait for him to declare bankruptcy, or...?

Two weeks ago my friend had a heart aneurysm that went undiagnosed for at least a week (he thought he had a horrible case of the flu). At about 5 days after the event, he went to the ER, as he was not getting better from his "flu" and was starting to experience kidney pain, and there he was given fluids and a prescription for potassium. He's relatively young and in good shape, so maybe there was little reason for them to suspect anything more serious, though he did say when they took his blood pressure it was shockingly low -- like 40/90 (or the reverse, can't remember which number comes first).

He assumed hydration and electrolytes would help him improve over the weekend but by Monday, a single flight of stairs was making him gasp for air, and his kidney pain had intensified, so he went back to the ER and was admitted with pneumonia. After a couple of days of poking and prodding, an EKG came in showing his aorta was swollen three times normal size. By that time apparently, he was also experiencing kidney and lung failure, and he also had a minor heart attack while in the hospital. He then had almost a foot of aorta and blood vessels replaced over a nearly 12 hour surgery.

Also, as his wife is in school right now and money was very tight and his employer did not provide it, he has no health insurance.

So... what happens in this situation? Does the hospital just sent the bill and wait for them to go bankrupt? They've got two children -- being saddled with $100,000 (or more??) of medical debt would make it impossible for to save up for their kids' future, much less their own. Does the hospital cut them a deal since they're self-pay and so very obviously unable to afford that much? Do they need to get a lawyer? Or some kind of patient advocate? What do people even do in this situation? (This is in Illinois, if that makes any difference.)

posted by hegemone to Work & Money (22 answers total)

When I was in the hospital recovering from Expensive Surgeries, a representative eventually came to inquire if I had insurance. I said, yes, but I also inquired why she asked. She said that if I didn't have insurance, she would try to sign me up for medicaid. This also happened to a friend of mine who had his appendix taken out. He qualified for medicaid after the fact. This is in NY though; I don't know about Illinois.
posted by milarepa at 5:11 AM on February 19, 2010

Does the hospital just sent the bill and wait for them to go bankrupt?

Sometimes. Hospitals have a certain amount of care that they do pro-bono for the poor. If you're medicare/caid eligible and not signed up, they try to work that. If you have assets, they'll want a share. Frequently they'll set up terms for you to pay over time.
posted by a robot made out of meat at 5:21 AM on February 19, 2010

Does the hospital just sent the bill and wait for them to go bankrupt?

IANAL, but I believe that in some (most?) states, one cannot discharge medical debt with a bankruptcy. Something similar happened to my father and he was saddled with hundreds of thousands of dollars of medical debt until he died. I'm sorry if this is upsetting news. Good luck to your friend (and to this country, should we not change our healthcare system).
posted by singerdj at 5:37 AM on February 19, 2010 [1 favorite]

He or his spouse needs to meet with a hospital social worker and start applications for Medicaid.

He may be qualified for Social Security Disability as well. (If he has a STD or LTD policy through work, he needs to pursue this as well.)

But he won't know what he's qualified for until he applies. The Medicaid process is usually pretty quick, but the SSDI will take a while.

Hospital social workers are overworked. He will need to stay on top of things to get this going. Don't be afraid to ask questions, especially if things seem to be lagging.
posted by FergieBelle at 5:49 AM on February 19, 2010 [1 favorite]

I keep reading on MeFi that U.S. hospitals will often whittle down a bill if the patient can't pay. Your friend will just have to talk things over with the hospital administration and find out what his options are.
posted by orange swan at 5:50 AM on February 19, 2010

The hospital can work out a payment plan and discount and like someone said, a lot do pro bono. He also should be qualified for Medicaid but I don't know if he can double up on the discounts (ie. Medicaid + hospital assistance + payment plan).

Do not ignore this issue. That's when people get in a lot of trouble.

Also, for his meds, call the pharamaceutical company, they also have medication assistance in a lot of cases. Otherwise go generic and/or ask the doc for free samples. When I was unemployed, I explained the situation and they gave me a discount for sick visits and gave me free samples of Zithromax. It helped. Heart meds are expensive and he'll be taking quite a few.

For his kid's sake, I sure hope he signed up for All Kids to ensure their medical coverage through the state. He really needs to in order to guarantee their wellness/sick visits and reduce the piling up of debt in case they get sick.

I will say I know that Advocate Christ Hopital in the SW side will work with patients (they are doing it for a family friend's kid). They're big on patient advocate/customer satisfaction so use the system to it's fullest.

Good luck to your friend, his family, and his health. But seriously encourage him to sign up those kids now!
posted by stormpooper at 6:04 AM on February 19, 2010

Seconding what others above say. There are payment plans, and state and federal programs for the poor. The hospital should actually be on top of this and can be very helpful -- after all, they want to get paid by someone.
posted by Cool Papa Bell at 6:18 AM on February 19, 2010

Do not ignore this issue. That's when people get in a lot of trouble.

I want to pop back in here and reiterate this. It will be a grueling few months sorting this out. I was getting bills a year later from doctors whose names I didn't recognize. However, it is way better to get started now than in 18 months when everyone has labeled him a deadbeat. My hospital stay was nearly $90,000, and I had "good insurance" at the time. Even with that, it was a bitch getting them to pay at times. It will take time to get it sorted out. It's the last thing you want to do as a young, struggling parent recovering from traumatic, horrifying surgery (ahh, good times), but he should get started now. He won't regret it.

Something nice you can do is buy him a 3-ring binder with plastic sleeves, ample folders, and some looseleaf so he can easily sort the flood of mail and organize the dozens of phone numbers he is going to receive. It seems stupid, but I assure you, they'll use it more than anything over the next few months.
posted by milarepa at 6:28 AM on February 19, 2010 [3 favorites]

Depending on what types of assets your friend has , bankruptcy may not be a very palatable option. (Specifically, I'm thinking that if he has a house, it is possible that he may lose it should he declare bankruptcy.) If this is an option that he is seriously considering, as always, he needs to talk to a local attorney, so that he will know what to expect. Prior to that, he should take a look at nolo.com's legal encyclopedia's entry on bankruptcy - it gives a very good overview of the law.

The more informed he is up front, the better this will be. Also, if he can show the hospital that he qualifies for a Chapter 7 (the type of bankruptcy where unsecured debts are mostly discharged) and has retained a lawyer to file for such, they will probably be very motivated to cut a deal.
posted by thewittyname at 7:12 AM on February 19, 2010

I'm in the software side of hospital billing as a profession. In my case I work for a non-profit hospital ssytem. Most of what I'll say has alrady been said but I just wanted to confirm and reiterate.

First, don't just ignore it. It doesn't go away.

I would advise your friend to appeal for charity from the hospital. Right now our charity appeals are way up considering the financial times we're in, but we are still giving the charity regardless. It's definitely worrth a shot. Also, most systems do offer a self pay discount of a sort. That said, I think our largest self-pay discount is around 25%. I realize that can be pretty significant but in your friend's case that's likely to leave quite a bit left to pay. This does not become a hopeless situation.

Here's the strategy I would use. Call the hospital billing department. Be honest with them about state of finances and set up a payment plan. Throughout the entire process be sure to take notes. Keep names, numbers and dates handy at all times when speaking with anyone involved in tis situation. Stick to the agreed upon payment plan as best they can. If your friend has a tough month they should call the hospital again and let them know if the payment will be short. DO NOT just let it go. Most hospital systems are glad to work with a person that is working with them to pay the bill. We regularly renegotiate the payment plans.

This will feel overwhelming but with patience, understanding and good note taking your friend will find this is much easier to manage than it first feels it will be.
posted by brokeaspoke at 7:16 AM on February 19, 2010 [2 favorites]

What people are calling "pro bono" is actually paid for by medical charities on your behalf, as brokeaspoke says. It's something you have to apply for & it may take some time to be approved so you'll keep getting bills in the meantime.
posted by scalefree at 7:47 AM on February 19, 2010

He should apply for charity care from the hospital. Also, I would like to mention that every hospital I have dealth with has no interest on payment plans - that might be obvious, but I didn't know that when I got bitch slapped with hospital bills. You can (and i have) renegotiated payment plans based on current financial standings - for instance, i started out paying 350$ a month and that got to be too much so I went down to 100$ a month. It was a simple phone call and actually not that bad. While I was in the hospital one of the nurses told me that as long as you pay something every month, they cannot send you to collections. She said that you can send five dollars during a bad montha nad that will keep you out of collections. I don't know how true that is, but you can negotiate a manageable payment plan.

Unfortunately, the debt will not magically disappear. Even with charity care he will likely have a few thousand dollars owed. Try to find resources to guide your friend because his scenario is very daunting (an very American grrrr).
posted by WeekendJen at 7:54 AM on February 19, 2010

Seconding the binder recommendation. I make that suggestion to anyone dealing with an illness or a confluence of a whole lot of doctor-type visits. Remember that there is a medical expense deduction come tax time, so all bills and receipts should be saved in the binder. Also, your friend should keep a calendar in the binder and note each day a trip (round trip or one way) was made for medical purposes, to assist him with charting gas mileage associated with medical needs. Obviously I am not making representations about what your friend can or cannot deduct, but keeping all the information is an important part of any aspect of this.

More pertinent bill-payment comments:

- Yes, to the social worker.
- Your friend may want to try to get the "insurance company" discount. Insurance companies have a contracted maximum rate, and so the hospitals discount to get to that rate and bill the insurance. Sometimes, a self-pay patient by asking can get that rate as well.
- A friend who works at a hospital here once told me that as long as you are making some kind of payment, even if it is very small, they can't send you to collections. I do not know if this is true, and would invite others with more info to correct me or not as the case may be. However, as crushing as it sounds, a generous discount followed by small payments over a very long time frame may be the result.
posted by bunnycup at 7:56 AM on February 19, 2010

Definitely look into charity care. I know plenty of people who have had their bills covered by the hospital and they were all people with jobs (just not very well paying ones.)
posted by vespabelle at 10:15 AM on February 19, 2010

There is a lot of potentially ruinous legal advice in this thread with regard to bankruptcy. Your friend needs to visit a bankruptcy attorney.
posted by seventyfour at 10:19 AM on February 19, 2010

Bunny cup, in my experience, it is true. That's how I pay our (too numerous) med bills for our son (and me).
posted by stormpooper at 11:09 AM on February 19, 2010

IANAL, but I believe that in some (most?) states, one cannot discharge medical debt with a bankruptcy.

This is wrong. For starters, bankruptcy is mostly federal law, and so does not vary among the states. There are exceptions to this, of course, but the exceptions don't really bear on the issue of discharge.

More important, the fact that a debt is "medical" does not mean it can't be discharged. There may be some other reason why it can't be discharged (for example it was procured by a fraud) but its being due to medical expenses is not one of them. Bankruptcy is, unfortunately, very complicated, and as has been mentioned above you should not under any circumstances rely on any bankruptcy advice you get here, or anywhere else on the web.
posted by lex mercatoria at 12:06 PM on February 19, 2010

In addition to applying for Medicaid, when I had my wisdom teeth out on an urgent basis because they were infected, my oral surgeon gave me an application that was called something like "emergency medical help for the indigent." I was newly graduated from college and hadn't found a job yet, but had just aged out of being covered on my parents' insurance. (Unfortunately my parents made too much money for me to qualify for that help personally.)
posted by IndigoRain at 12:13 PM on February 19, 2010

The hospital can work out a payment plan and discount...

Negotiate!! I recently had a motorcycle accident, and my resulting surgery was paid in part by my medical insurance, with the remainder being paid by my motorcycle insurance. In looking over all of the billing with my lawyer, it turns out that my $50K surgery was taken care of by the insurance companies for a total of under $10K.

Similarly, when I needed an MRI, I found out that I still had a $600 bill for a previous MRI from several years ago. They happily settled the account with me for $150.

Be aggressive - they'd rather get something than nothing.
posted by coolguymichael at 1:15 PM on February 19, 2010 [1 favorite]

IANAL, but I believe that in some (most?) states, one cannot discharge medical debt with a bankruptcy.

Actually, I was in a car accident, had no insurance, and declared bankruptcy. The hospital was not willing to negotiate, and the car insurance company deemed it an "Act of God," i.e., there was no one I could sue. Medical bills are one of the most common reasons for personal bankruptcy. I suppose in some cases, you can fight and work out payment plans, but my hospital was very aggressive and inflexible about payment, so bankruptcy was much, much easier.
posted by blazingunicorn at 2:10 PM on February 19, 2010

My advice is pretty basic.

1) Your friend can never forget that if he had insurance, there is no way the insurance company would be paying out anything close to the "list" price the hospital and all its affiliates put on their bill. Coolguymichael's experience strikes me as pretty typical.

2) 1) Hold on to every cent he has for as long as possible. Don't pay anything until everything has been negotiated wayyy down. Be very skeptical of any charity or public assitance program that requires your friend go broke before he qualifies.

My father was uninsured when he was hospitalized, and the hospital social worker seemed to be guiding him towards putting his entire retirement savings on the line with the aim of qualifying for public assistance, well before the idea of negotiating the bills was ever discussed. Come to think of it, once my father died, the attorney we had help us settle his estate simply negotiated the bills down from the point of view of "this is what the estate has" rather than the perspective of what they would have been paid had he had insurance, which I'm realizing was probably a mistake.
posted by Good Brain at 4:52 PM on February 19, 2010

I am an ICU nurse and we deal with patients like this all day long. The best thing I can recommend for your friend at this point in time is to make sure that he is meeting with the hospital social workers and keeps pressing to meet with them until he is satisfied with his payment plan. We have some absolutely incredible social workers at our facility that do miracles by knowing who to talk to and how to talk to the hospital.

That being said, your friend has had some incredibly traumatic and painful surgery. The recovery period is long and fraught with potential issues. He's going to need a lot of support from his family and friends to make it through this as sane as possible. Kudos to you for helping him.
posted by nursegracer at 8:56 PM on February 19, 2010