WBEZ | Insurance

Uninsured patients sue Chicago nonprofit hospital

Thu, 29 Nov 2012 10:56:00 -0600

A lawsuit filed Thursday claims a nonprofit hospital in northwest Chicago failed to provide charity care to two low-income, uninsured patients, reopening a longstanding controversy in Illinois over whether hospitals are doing enough charitable work to qualify for lucrative tax exemptions.

Swedish Covenant Hospital repeatedly lost one patient's financial assistance application and threatened to send her bill to a collection agency, according to the lawsuit. The hospital incorrectly told another patient she was ineligible for assistance and demanded cash from her, the complaint alleges.

The practices amount to "bureaucratic barriers" that prevent eligible patients from getting free care, according to the lawsuit, and the hospital has a policy of attempting to collect from "even the poorest of patients" through bill collectors and wage garnishment.

The hospital gets about $8 million in annual tax breaks and owes the community a more reliable charity care system, the plaintiffs' attorney Alan Alop of the legal services group LAF said at a press conference Thursday in Chicago. The lawsuit claims unfair practices under the Illinois consumer fraud law and seeks $50,000 in punitive damages and a change in hospital policy.

Swedish Covenant spokeswoman Leigh Ginther said Thursday she couldn't comment on the lawsuit, but she said every patient who is identified as uninsured is given an application for charity care and a personal explanation of the process.

"It is the patient's responsibility to return the completed paperwork," Ginther said. The hospital reported $6.2 million in charity care expenses last year, nearly 3 percent of its net revenue.

Nearly 2 million Illinois residents are uninsured, or about 15 percent. The state constitution, court decisions and state law require Illinois hospitals that receive tax exemptions to provide charity care, but until this year the definition of charity wasn't clear.

The lawsuit comes as Illinois Attorney General Lisa Madigan is writing new standards on hospital charity care as required by a law passed earlier this year.

A Chicago-based advocacy group, the Fair Care Coalition, wants Madigan to recommend that a standard, universal financial assistance application be used by all Illinois hospitals. The group also wants a thorough reporting mechanism so the public can check that hospitals are obeying the law, said Janna Simon of the coalition.

At the press conference, plaintiff Ramona Ortiz-Patino described filling out multiple applications for financial assistance and later being told the hospital hadn't received them. An unemployed diabetic, she was facing charges for emergency room visits for extreme pain in her right leg.

After Ortiz-Patino submitted a third application, a hospital employee telephoned her and "let me know that my bill would be going to collections because I hadn't paid it," she said. "I didn't understand why the hospital was threatening me when they knew I had zero income and I submitted three applications" for financial assistance.

How much charity care should nonprofit hospitals provide? The issue has been brewing for years in Illinois.

In 2009, two large Illinois hospital systems settled class-action lawsuits that claimed they had overcharged uninsured patients. In separate settlements, Resurrection Health Care and Advocate Health Care agreed to pay refunds to tens of thousands of individuals.

Next, a 2010 Illinois Supreme Court ruling suggested nonprofit hospitals that behave like businesses shouldn't qualify for tax exemptions. Citing that court decision, the state Department of Revenue denied tax exemptions to three hospitals in 2011 and signaled more denials for other hospitals could follow.

That set off a storm of controversy the Legislature addressed this year.

Nonprofit hospitals won a broad definition of charity care from Springfield in a new state law that will allow them to continue their tax-exempt status. Hospitals were required to provide free care to patients of certain income levels, and the attorney general was directed to write standards for hospital financial assistance applications.

Helping keep dancers on their (healthy) toes

Mon, 16 Jul 2012 05:14:00 -0500

A social service group for performers is trying to increase the number of dancers with health insurance in Chicago.

The Actors Fund says nearly one in every three dancers is uninsured.

Christina Gonzalez-Gillett is assistant director of The Seldoms, a small dance company here that can’t afford to provide health insurance.

“If there is coverage for individuals, I think the dancers would be really happy about that because we have to work so many jobs just to be able to afford stuff," Gonzalez-Gillett said. "Starbucks is like the ultimate 'dream job' because they offer health insurance.”

The Actors Fund is holding a forum Monday evening at the Chicago Cultural Center to talk about new options under health care reform and how to get insurance here.

James Brown, who directs the Fund's Artists' Health Insurance Resource Center, said health care coverage would allow dancers to focus on their art. He said by 2014, insurance companies won't be allowed to deny coverage because of old dance injuries.

"Just a few days in the hospital could put them a few thousand dollars in debt," Brown said. "So that anxiety and that threat that’s there from being uninsured is removed.”

Brown said dancers are more likely to be uninsured because they are young and often have low incomes.

Uninsured largely unaware of benefits coming from overhaul

Mon, 29 Aug 2011 15:28:00 -0500

When it comes to last year's Affordable Care Act, there's not much people agree on. Except, says Kaiser Family Foundation President and CEO Drew Altman, this one thing: "It really does help the uninsured; 32 million uninsured people will get coverage."

But according to the foundation's latest monthly tracking poll, it appears that only about half of uninsured people have any idea that help is on the way. And fewer than a third (31 percent) say they think the law will help them obtain health insurance.

Those two things are clearly linked. Among those lacking insurance, 41 percent incorrectly think the law lacks provisions to help those with modest means pay for health insurance (7 percent said they didn't know) and 37 percent incorrectly said the law doesn't include an expansion of the Medicaid program to low-income, able-bodied adults (16 percent weren't sure).

The logical conclusion, Altman wrote in an accompanying column, is an apparent "communications failure" on the part of the law's supporters to explain how the measure will actually work. But in that column and a subsequent interview, Altman said there's more to it than that.

"What's going on here is people who are uninsured are busy just trying to make it through the week, paycheck to paycheck," he says. Meanwhile, he adds, "they're listening to a confusing political debate."

But the bottom line, he says, is that the health overhaul will probably start to sink in in 2014, "when there are benefits out there, real coverage out there that people can look at — and can get...."

That's when people without insurance will really make a judgment about whether they can afford insurance or they like the law or it helps them. "Until then," Altman says, "it's just a political debate."

Allstate hikes rates for Illinois homeowners

Fri, 15 Jul 2011 20:59:00 -0500

Northwest suburban-based Allstate is hiking it's rates for Illinois homeowners. Allstate has nearly half a million home-owner policy-holders in Illinois. They can expect hikes between two and a half percent and nine percent.

Spokeswoman Shaundra Turner said the climbing costs of paying claims are to blame. "Factors such as the number of claims, the frequency of claims and weather over the past several years all result in these increases in cost," she said.

Turner said severe Midwestern storms mean higher rates for Minnesota and Wisconsin customers, too. This is the third summer in a row the insurance giant has raised homeowner rates in the state.

To reduce the hit to customer pocketbooks, the company is offering discounted rates for those who bundle various Allstate insurances, pay their premiums in full or have premiums automatically withdrawn from their bank accounts.

Writer Patricia Hitchens reflects on reaching Medicare age

Tue, 31 May 2011 14:49:00 -0500

There may be less choice when it comes to where patients get their healthcare. But there is certainly no lack of entities who want to handle your insurance, from the government to private insurers.

That’s true especially as you get older.

Writer Patricia Hitchens finds it all adds up to feelings that range from annoyance to dread.

The Medicare come-ons BEGAN coming in January. How odd, I think, Mother died four years ago. What a pain, getting her junk mail again.

Actually, it is my junk mail. I discover that the intended “Medicare Recipient” is not my mother, but me.

Most of the Medicare mail is not from the government or Social Security, but from companies hoping to cash in on the profit potential of baby boomers. Why be satisfied with government insurance? the pile of envelopes seems to say. We’ve got you covered! Their contents include scads of grinning oldsters making the most of their sunshine years -- all exuding heart-felt relief at having made the “right” choice in healthcare coverage.

Because I’ve been fending off AARP since my kids were in middle school, I decide to give them first crack at me. Featuring a photo of a forty-something woman under an ominous thunderhead, it begs urgently for attention.

Turning 65? asks the envelope. Worried about your health care coverage?

Well, yes, I admit, and No. My health and my health insurance are both excellent.

The inside cover invites me to Meet Ava – who, coincidentally, also turns 65 this year!

Instead of cowering under a fearsome thunderhead like the AARP woman, the Blue Cross people are all smiling, some even laughing over some shared funny story. Often they are also clutching a spouse, adorable grandchild, fishing rod or golf club. One couple is even rolling around on the grass, like the people in those erectile dysfunction commercials. I can almost hear the announcer intoning, Will you be ready?

Humana Healthcare’s packet is more down-home, with a snapshot-style picture of a heavily made-up celebrant behind a birthday cake. This birthday, remarks the adjacent copy, brings with it a Special Opportunity.

But I don’t want this special opportunity, not from Humana, Blue Cross or United HealthCare. At least, not yet. Because I’m not ready for what it comes packaged with: a peer group I don’t like the sound of.

Notwithstanding the youthful types in these Medicare brochures, they are aimed at senior citizens. Citizens otherwise known as “old”. “Senior citizen” is supposed to have been trotted out during a political rally as a pleasing euphemism for “elderly”. I remember when “senior” sounded terrific: I yearned to be a “senior” in high school, couldn’t wait to become a “senior producer” at my TV studio, and later at my consulting firm, preened when promoted to “senior consultant.”

If adding “senior” to “citizen” once sounded honorific, today it sounds anything but - which is why I balk at my prospective new packaging. Take the deprecating “senior moment”: it means not an idyllic interlude - but terrifying seconds of lapsed recall. While I am considered productive now, in one month will I automatically stop functioning, disappearing “over the hill” into senior-citizen land?

My husband and I have wills, long-term care insurance, beefy retirement accounts. All against a far-off need, sometime in the distant future. Yet with all that get-ready-for- Medicare mail jamming the front porch mailbox, said future no longer seems way down the road. Instead, it squats just outside our door, a thief lying in wait.

Among rich countries, U.S. rates worst for patients

Thu, 18 Nov 2010 12:39:00 -0600

When it comes to health care, it's generally the case that the care in wealthy countries is better than in impoverished ones.

But a country's GDP only goes so far in predicting how things will go, as a survey of the some of best-off countries finds.

Take a guess which rich country's health system provides the worst experience for patients?

Yep, it's the United States, according work released today by the Commonwealth Fund. Not only do Americans avoid doctors when ill for fear of being slapped with big bills, but they also shell out far more when they do go, even if they have insurance.

The findings, published in the journal Health Affairs, looked at 11 developed countries and compared the experience of patients -- from costs, to paying medical bills, to dealing with insurance companies.

The U.S. came out at the bottom on almost every count, sometimes with shocking gaps between it and the next country.

Here's a rundown of the various ways the U.S. is falling behind Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom:

Only 58 percent of U.S. adults said they thought they could afford the care they needed

A solid 20 percent of U.S. adults had major problems paying medical bills, compared to 9 percent in France, with the next highest figure

31 percent of U.S. adults reported getting caught in insurance problems: either dealing with mountains of paperwork, having their insurer deny a claim, or receiving a lesser payment than expected

Americans are coughing up more from their own wallets: one-third of U.S. adults paid $1,000 or more out-of-pocket in the past year for medical bills, much higher than all of the other countries.

Among the worst-off are uninsured Americans: nearly half of them went without needed care and one third had problem with bills

But some of this should change with the passage of the health care overhaul, which will make sure the 32 million Americans without coverage get it. According to Commonwealth Fund President Karen Davis, the bill will make new insurance options for the uninsured affordable, ensure insurance pays for essential care, and improve financial security for millions of Americans.

Even amid the gloom of survey, there was one bright spot for beleaguered Americans: we do seem to have pretty good access to specialists. Outscored only by Germany and Switzerland, 80 percent of U.S. patients who need a specialist see one in less than four weeks.

A year ago, an analysis by the Organization for Economic Cooperation and Development reached some similar conclusions. America got good marks for cancer care and not-so-hot grades for primary care. Copyright 2010 National Public Radio. To see more, visit http://www.npr.org/.

Auto collisions with deer pose a health risk

Tue, 02 Nov 2010 16:23:00 -0500

In Maryland, where I live, there's a 1 in 119 chance that I'll hit a deer with my car in the next year.

Overall, there's a 1 in 183 chance of an American driver doing the same thing, according to claims data crunched by insurer State Farm. As the deer population has zoomed in recent years, so has the number of crashes.

State Farm figures the collisions -- more than 1 million annually -- are up 21 percent in the last five years. And beware: now through the end of the year is peak crash season.

Nobody wants to hit a deer. It's probably curtains for the animal and may not be so good for you. More than 1,000 people died in collisions with animals during the five years that ended in 2009, according to federal data the folks at the Insurance Institute for Highway Safety passed along.

About 3 in 4 collisions between cars and animals involve deer. The Washington Post's Allan Sloan, who zeroed in on the economic cost of the deer overpopulation problem, put the annual human death toll from crashes into the animals at 140.

The likelihood of an accident with a deer varies a lot by state. West Virginia, for the fourth year in a row, leads the deer-crash pack with a driver's annual odds of a collision at 1 in 42, according to State Farm.

Out in the West, the risks subside. And in Hawaii, the chances for a crash are pretty darned slim at about 1 in 13,000. (Check out the map from State Farm for info on your state.)

Just because you hit something doesn't mean you have to get seriously hurt.

"In most cases the fatal crashes could have been prevented had the motorists taken the basic precaution of putting on a seat belt," IIHS spokesman Russ Rader tells Shots.

Also, he says, the research shows deaths aren't usually a direct result of hitting the animal. It's the secondary impact with another vehicle or going off the road that proves fatal.

Motorcyclists also hit deer, and Rader says not wearing a helmet is a big factor in which of those collisions lead to drivers' deaths.

Deer, while the biggest problem, aren't the only road hazard. There are also wild boar to worry about. Dr. Billy Higginbotham, a wildlife specialist with Texas A&M's AgriLife Extension Service, figures a vehicle plows into feral hogs at an annual rate of about 1 percent.

He says nobody knows exactly how many feral hogs are out there, but it's a big and growing number. "Feral hogs are the most prolific large mammal on the face of the Earth," he said in statement. "There's no question about that."

Q&A: COBRA confusion? Your questions answered.

Fri, 06 Mar 2009 10:56:00 -0600

A lot of you have probably heard about recent changes to the Consolidated Omnibus Budget Reconciliation Act, or COBRA. COBRA gives workers and their families who lose health benefits because of job loss the right to receive continued care. Under new legislation, certain individuals eligible for COBRA coverage may receive a subsidy for 65 percent of the premium (these individuals are required only to pay 35 percent).

But how does it all work?

Below, Fred Garfield, Senior Vice President of benefit solutions at The Horton Insurance Group in Orland Park, Ill., answers some important questions about the new legislation. 1. What specific steps must I take to claim this premium reduction? The employer is required to send a written notice and enrollment form to the employee no later than April 18th, and the employee has 60 days to notify the employer of their desire to accept. Acceptance would be retroactive to March 1, can only be taken for the employee and those dependents covered at the time coverage was initially lost, and full payment of the premium, less the 65% federal subsidy amount, retroactive to March 1 must accompany the written reinstatement request. 2. If I did not enroll in COBRA when I was laid off, can I definitely enroll now and receive the premium reduction? Yes, however only for yourself and those family members you covered at the time you were laid off. You will receive the reduced premium cost for up to nine months. 3. If I am an employer, how does the new legislation affect me--how will I be reimbursed? You can take your reimbursement as a reduction of the payroll taxes (FICA and Medicare) you report on your quarterly 941 report. Instructions on how to do this, including recordkeeping, was provided on the IRS website and was described in one of our prior handout attachments. 4. Is the government likely to extend this legislation past Dec. 31 2009? If the economy turns around, it would be unlikely, but this is hard to predict. We know at this time it is not extended to any individual COBRA beneficiary beyond the nine-month subsidy period. The government did this in recognition that without insurance people would likely get no preventative care, and more serious illnesses would be coming through the emergency room at much higher, uncontrolled cost. 5. What happens if I reach the end of my maximum COBRA coverage period?

At the end of COBRA, the options include taking individual coverage (subject to medical underwriting), converting the COBRA to an individual policy (very limited coverage and extremely expensive), signing up for the State I-CHIP high risk program (also limited coverage and high cost), or if financially qualified getting financial assistance to acquire or purchase coverage through the Illinois State Medicaid program. Some short-term or "bridge" policies can provide current coverage (no pre-existing conditions) and they do not qualify as "HIPAA Compliant Credible Coverage" to offset pre-existing conditions on a new employer sponsored group plan.