Credit and blame for North Carolina Hospitals

If you haven’t read the articles in the News & Observer and Charlotte Observer series on hospital profits and charity care you should check them out here. The reporters found some astounding stories.

I had several thoughts while reading these investigations. I’ll start by giving hospitals credit where credit is due. Hospitals, like all of us, are trapped in a terribly broken health care system. They have to deal with a huge number of moving parts including insurance company negotiations, quality reporting, changes in public programs, competition with other hospitals, etc. A hospital, for example, might feel forced to buy the latest and greatest equipment, even if it does not improve care, to attract the wealthiest and best insured patients. This can offset some of the free care given to uninsured patients.

Hospitals recognize that the system is senseless. That is why hospital associations both nationally and in the state endorsed health reform. I respect that. Many insurance companies claim that they want reform and then oppose any actual law that is drafted. Some even send post cards and make illegal robocalls to defeat health reform proposals.

Now on to the blame. No matter how desperate the situation for hospitals, it is appalling that a huge system like Carolinas HealthCare would sue thousands of patients. It is especially galling that they would pursue someone like Joyce Jones, a woman who paid property and sales taxes for years to support Carolinas. The hospital then billed her for $34,000, put a lien on her house, and refused to accept her offer of $10,000 and a payment plan.

This is a multi-billion dollar health system ruining a patient’s life over less than $20,000. They should be ashamed.

Hospitals do much good in our state. And, as the stories reveal, their billing practices are causing great pain. They should get credit for recognizing that we need change and endorsing the Affordable Care Act. But they should immediately stop suing poor people and impounding their homes.


  1. Tim

    April 25, 2012 at 3:30 pm

    I’ve had an ongoing issue with one of Raleigh’s hospitals. After having chest pains (two brothers died of heart issues) I went to the Emergency Room early one morning. After being admitted to the ER, and spending approximately 12 hours in ER, never leaving ER unless being wheeled to one testing room or another, I was finally discharged from ER. As I was leaving, they requested I pay my insurance company’s ER co-pay ($150).

    Two weeks later, I get an invoice from the hospital for approximately $1,350, which was the difference between my ER co-pay and my insurance deductible amount. Seems my time in ER, including the time they spent checking me in to ER, waiting in ER, getting checked out of ER, and paying my ER co-pay was actually out-patient per the hospital.

    A few months after that I had a kidney stone. I was checked into a different hospital’s ER, spent 6 hours in that ER, checked out of that ER, and paid that hospital my $150 ER co-pay. Amazingly, that 2nd hospital has actually treated my ER stay as (are you sitting down?) and ER stay!

    If that first hospital were to simply resubmit my bill to my insurance company, they will get paid. But, nope, they refuse to do that.

  2. Dan

    April 27, 2012 at 1:09 pm

    Tim, most likely it is your insurance company that has decided that your visit was not emergent, and, therefore, not reimburseable at ER rates. It is EXTREMELY unlikely that the hospital is to blame for that. Check your EOB or call your insurance company and find out what happened.

    Working in the healthcare industry for the past 15 years as a consultant, I feel very bad for hospitals – they can’t win. Should they not be paid? If I ignore all statements and attempts to collect for a service that I received, I shouldn’t be held accountable? Every hospital has programs and an army of people standing ready to help – but when a patient like Joyce Jones just doesn’t respond at all to attempts by the hospital to contact her about what HER INSURANCE COMPANY SAYS SHE OWES (remember, it’s not the hospital that decides what you owe, it’s your insurance company – in the case of an uninsured patient, almost all hospitals discount just like they do for insurance companies AND offer mutliple programs to help – all the patient has to do is work with them – call them back – respond to their letters/statements), the hospital gets the blame.

    Patients, if you owe money, call the provider (hospital). If you ignore it, it won’t go away and you may lose an opportunity to mitigate the amount owed, and you can’t really blame the hospital for that.

    Bottom line, the hospitals are being blamed for the ills of the entire system. You think they wouldn’t be happy to operate like any other business? Next time you go to Jiffy Lube for an oil change, try to give them your auto insurance card and see if they are willing to work with a third party on your behalf to maybe get paid for the work they perform at some point down the road. And, then, months later, be willing to incur the costs to bill you and collect what your auto insurance company says is your share. Imagine how much they would have to charge for that oil change to incur those extra costs – and picture how much more your auto insurance would cost since it would also cost your auto insurance company more. Or perhaps going to Home Depot or Lowes and instead of paying for your purchases, you give them your home insurance information. It’s ludicrous, right? Now you see why healthcare is such a mess – we don’t have a healthcare system problem, we have a healthcare reimbursement system problem.

    Everyone would be wealthier and happier if healthcare insurance was really insurance – you pay cash for the services you consume, with some form of government intervention for disadvantaged people that can’t afford, and insure yourself against significant financial loss due to healthcare expenses – healthy patients pay WAY less out of pocket annually, sick patients are insured against significant financial loss by REAL insurance, physicians and hospitals have significantly less costs and can therefore charge less, employers have less costs and can therefore create more jobs and/or more investment, and insurance companies can go back to providing insurance instead of a glorified subscription-based discount program. Plus, if we really want to go down this road, hospitals don’t have to be not-for-profit – because they are allowed to operate like any other business, and they would be happy to pay taxes after you cut away so much of their costs.

  3. Adam Linker

    April 27, 2012 at 1:16 pm

    Joyce Jones did respond. She offered $10,000 and a payment plan. They rejected her offer.

  4. Dan

    April 27, 2012 at 6:07 pm

    AFTER they had already filed the lawsuit – no response to the original bills.

  5. Adam Linker

    April 27, 2012 at 6:11 pm

    Because they sent it to the wrong place. And, yes, hospitals are supposed to give care to some people without demanding payment. It’s called charity cars and it’s why Carolinas gets hundreds of millions in tax breaks.

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