How to advocate for and aid a desperately ill, uninsured man in California?

January 3, 2008 3:36 PM

How to advocate for and aid a desperately ill, uninsured man in California?

Posting this for a friend:

His older brother is in his mid 40s, single, lives with their father. He has no insurance, and has previously been in good health. On 12/23 he began complaining of flu symptoms. On 12/26, after two days of Nyquil and Theraflu, he claimed to feel better. But the next day, 12/27, he was found in bed in soiled sheets. He was carried into the ER in Alhambra, CA, where he was found to have liver and kidney failure. He was immediately put on life support, and is now on a respirator as well.

The ill man has $30,000 in his checking account (his bill is already more than that). No one can access these funds, and the hospital is eager to receive some payment ASAP. His relatives need to obtain power of attorney, to access his funds and to be able to make decisions about his care. There is no will and no former spouse.

His brother is in the process of getting him on Medi-Cal retroactively. What else can he do, who else can he call, to help his brother in this crisis?

Please advise. We will pass any suggestions along to our friend immediately.

posted by Scram to law & government (9 answers total)

I'm not from California, or even remotely familiar with things there, but I'd suggest contacting his/your local Senators / Representatives, who try to be well-known for providing "constituent service," such as helping out people in situations like this.

Wishing your friend's brother a successful recovery!
posted by fogster at 4:08 PM on January 3, 2008

Whilst the context isn't quite what you're looking for, the sentence, "Information on the patient's bill of rights is available by calling the California Hospital Association at 800.494.2001" suggests that they may also be a good resource for information on hospital policies.

The other part is legal advice, but not being from anywhere near California, nor knowing much about the law, I'll let someone else take that one.
posted by fogster at 4:19 PM on January 3, 2008

There's not a lot to do but call Medi-Cal and ask for their help in working with the hospital.

If you get an attorney involved, they might be able to get a judge to grant power-of-attorney for a limited period for access to money.

Personally, I'd be a bit wary of handing cash to hospital at this time without some clarity on what Medi-Cal can/will do. Someone with $30k in the bank might not meet the eligibility requirements, but I'm not sure.

Several years ago, I had double pneumonia & sepsis and spent 3 days in the ICU and 3 more days in the hospital. The initial bill was over $53,000. My insurance worked with the hospital and knocked the price down to under $25,000. Thanks to my insurance, I only paid $250.

The point being, that the price for hospital care at this level needs to be negotiated to a reasonable level. Simply handing over what ever the hospital asks would be wrong.

Some hospitals have Omsbudsman that are there to help from the patients point of view. The ill man is probably at Alhambra Hospital (near my house). I can't see from the web site if they have an omsbudsman. You'd likely need to call.
posted by Argyle at 4:36 PM on January 3, 2008

If Medi-Cal turns him down, you might be able to get him assistance as medically indigent or through one of the other programs for people who fall through the Medi-Cal cracks.

The hospital should have a "patient advocate" on social workers on staff. Hook up with them immediately; their job is to help people find services you don't know about yet, and to navigate the maze of medical bureaucracy.

The healthcare industry's dirty little secret is that there are two sets price lists: the published ones apply essentially only to the uninsured, while deeply discounted rates are negotiated by insurers on behalf of their subscribers. Your friend's brother is being quoted a grossly inflated price that no one but the independently wealthy is ever expected to pay in full. With extremely little effort, you should be able to get at least 50% knocked off the quoted bill. Consider that absolutely just a starting point for negotiation; if all you get is a 50% "discount", they're still taking in far more for his care than they would if he'd been insured. So DO NOT FEEL BAD ABOUT PUSHING THEM FOR 60%, 70%, or even 80% off. They won't make that kind of concession nearly as easily, but just know that you can press that hard without being a dick.

If it's a nonprofit hospital, also apply to their charitable care fund. See my previous comments for more info on this, and other ways to reduce the bill.

Caution! The hospital's bills are merely the tip of the iceberg. Every single doctor, radiologist, etc. bills separately for their own services. So whatever you agree to give the hospital, make sure you're keeping at least half of your/his resources in reserve for paying the set of bills you haven't even seen yet. (And unfortunately, they're harder to negotiate down than the hospital, plus you'll have to bargain with their A/P reps individually. A big project in itself.)

Before you pay any bill, submit it to a professional medical bill reviewing service. For the level of expense you're dealing with, their service will surely pay for itself and more.

Finally, when you've arrived at a price that is reasonable and correct, have the whole thing put on a payment plan. Yes, the hospital is eager to have cash now. Naturally. But don't let them push you into bankrupting him, or yourselves, to meet some arbitrary deadline. The truth is, they can -- and customarily do -- wait a long time to get such bills settled.
posted by nakedcodemonkey at 5:24 PM on January 3, 2008

correction: patient advocate or social workers
posted by nakedcodemonkey at 5:25 PM on January 3, 2008

scram, I asked a non-Mefite doctor friend to look this over and his paraphrased advice was "tell them to tell the hospital to go fuck themselves while they do what they need to do to work out power of attorney. If he is on life support and a ventilator they will NOT kick him out into the streets and while they may be unpleasant, they will not get nasty" So, I have no other specific help in this regard but to offer encouragement that while working out agreeable terms with the hospital is in everyone's best interests as well as keeping lines of communication open. Your friend and his family are in a tough emotional state and they should do nothing concrete regarding payment or even admitting who has what money until they have gotten good advice regarding insurance and power of attorney. Good luck, I am sorry this happened to your friend.
posted by jessamyn at 6:44 PM on January 3, 2008

Thanks, everyone. The thread has been shared with our friend, and I know he will appreciate these and any further suggestions.
posted by Scram at 6:45 PM on January 3, 2008

Social Services Consult, immediately. His doctor should already have ordered it. This happens all the time. And good luck. It sounds very sad.
posted by docpops at 7:42 PM on January 3, 2008

I'm surprised the hospital has not referred your friend's family to their internal patient advocate- this is a standard position at most hospitals, and the advocate can offer the guidance you need to sort out the power of attorney problem without you having to pay for a lawyer. Also, your local Legal Aid office will doubtless have a great deal of experience in contending with these questions.

As for the staggering cost of care- as others have suggested, most hospitals have financial aid programs, though often they don't volunteer information about them. They require documentation- such as tax returns and payroll stubs- but they also pay attention to explanations of specific circumstances that merit special consideration. My sense is also that hospitals are pleasantly surprised when you contact them and express willingness to work something out (instead of ignoring the bills and having to be tracked down by a collections agency). I had a job and private health insurance when I was hit by a car, but with no savings (I'd been a grad student for the past 7 years) I still couldn't manage the final hospital bill after insurance kicked in. I was able to negotiate a substantial cut in the bill- about 30%- and work out a reasonable installment plan.

I think it helped that I had insurance, since it meant that the hospital already had received some compensation. However, as others have noted, non-profit/charitable hospitals have more flexible policies on writing off bills. During a long hospital stay for a very serious illness (why yes, I do have bad luck), the hospital I received treatment at wrote off hundreds of thousands of dollars in unpaid costs since my insurance behaved like one of the companies in "Sicko" and refused to pay for covered services at an in-network facility. You may need some legal help on this, and Legal Aid is a very good resource for this kind of advice as well.

And it doesn't hurt to write your congressperson.
posted by foxy_hedgehog at 8:06 PM on January 3, 2008