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Bill Could Aid Uninsured Patients

Legislation: A proposal would limit hospital fees for those without insurance and require that they be told of charity-care policies.


After a fainting spell in November, Cerritos College student Soklinda Em landed in a Norwalk hospital emergency room for six hours.

Although her health is now fine, her pocketbook is not.

The hospital bills--totaling $4,572.97 at last count--are now threatening to ruin the 21-year-old's credit.

"It's just awful," said Em, who quit her job, which provided her insurance, just a month before her fainting spell.

Consumer advocates say Em's case exemplifies the dilemma of many uninsured hospital patients in California: Though they can't afford to pay top dollar for treatment, they are not entitled to discounts that hospitals give to government programs and insurance companies.

At a Sacramento news conference Tuesday, consumer groups rallied behind proposed legislation that would cap the fees that hospitals could charge the uninsured. The bill also would require hospitals to inform all patients of their charity-care policies and check whether patients are eligible for public insurance programs.

"Right now, hospitals bill the uninsured the highest possible rate, which is overwhelmingly unaffordable," said Anthony Wright, organizing director of the consumer group Health Access. "These bills get sent to collections and ruin the financial futures of these families, and the hospitals get nothing...."

Lt. Gov. Cruz Bustamante agreed. "Hospitals should be providing care. They shouldn't be taking advantage of these folks," he said.

The hospital industry, however, says that defeating the legislation is its top priority this year. "We're all-out opposed to it," said Jan Emerson, spokeswoman for the California Healthcare Assn., a hospital trade group.

Emerson said society at large, not just hospitals, must deal with the problems of the uninsured.

The state should spend its money to expand public programs, employers should offer health coverage to more workers, and workers should purchase insurance when it's offered, she said.

The problems of uninsured patients are well known. In 1999, for example, nearly 500,000 Americans filed for bankruptcy protection because of excessive medical bills; that accounted for 40% of personal bankruptcies that year.

But the issue has gained traction lately. In February, a group of former patients sued Tenet Healthcare Corp., saying the nation's second-largest hospital chain overcharged poor and uninsured Latinos as part of a scheme to take advantage of a federally funded charity care program.

Tenet, based in Santa Barbara, argues that the suits lack merit and are politically motivated.

Some uninsured Californians say they have tried unsuccessfully to work out payment arrangements with hospitals.

Sam Cano, 67, sought care for a throat infection in August 1998 at Queen of Angels-Hollywood Presbyterian Medical Center, owned by Tenet. He said he was discharged after five hours, having received X-rays, a tetanus shot and IV antibiotics. The bill: $1,700.

Cano said he was rebuffed when he tried to negotiate a lesser payment of $500 or $600. He then ignored the bills and notices. This year, when he went to refinance his home, he discovered a lien for $2,800 (including legal fees). He paid the bill last month after borrowing money from his son.

"I had no money to hire an attorney ... so I let it go," he said.

Tenet spokesman Greg Harrison said he could not discuss individual cases because of patient privacy rules. In general, he said, Tenet pursues liens only as a "last resort."

Susan James, 48, said she doesn't know what to do about the $302,744 hospital bill that arose after her husband fell from his roof in November. Jesse James, 42, suffered severe brain damage, and his wife quit her job as a paralegal to take care of him.

Susan James said Loma Linda University Medical Center initially told her that she would have to pay the entire bill over time or it would be turned over to collections. Months later, the hospital told her about its charity care program, she said, and she is now waiting to hear if she is eligible.

"Nobody's going to benefit from ruining my credit," she said. "All they're going to do is stop me from getting money to feed my husband, feed myself, get prescriptions and things I need. I would love to go back to work."

Loma Linda officials declined to comment on the case.

State Sen. Deborah Ortiz (D-Sacramento), who sponsored the charity care bill, said such stories "have been very, very consistent. We really need to have [hospitals] step forward and do more. Hospitals ought not to bear 100% of the social problem that we're facing. I think they could do better, however, by increasing their percentages of providing charity care."

At Tuesday's news conference, Consumers Union unveiled an analysis of state data showing that hospitals expend an average of 1% of their operating expenses on charity care. Many hospitals reported no charity care at all.

The hospital trade group says that all hospitals provide some degree of charity care, although some don't report it properly.

If patients provide financial documentation, Emerson said, hospitals try to enroll them in public programs or create a payment plan. The problem, she said, is that many people don't communicate with the hospital.

"So, the only way that a hospital has to engage them is through a billing process and, unfortunately, sometimes a collections process. That's not our goal."

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