When Magdalena Evans experienced stomach pains that started to spread to the rest of her body, she immediately consulted her direct primary care doctor. The follow-up CT scan showed she had a gastrointestinal stromal tumor in her small intestine. Her direct primary care physician (DPC) referred her to Ascension Dell Seton for a surgery to remove the tumor. The surgery was successful, but what happened next shocked her—the hospital sent her a $60,000 bill for her stay.
She asked if any type of financial assistance was available after her surgery. She was told by hospital administrators that it was too late for her to apply for financial assistance since they had already performed her surgery—which is worrisome considering Ascension’s financial assistance webpage does not mention a timeframe for when bills have to be paid. “They knew I was an uninsured and a low-income patient. They did not seem too concerned about my financial situation,” said Ms. Evans.
Even worse, just a month after her surgery, she received bills in the mail from the hospital financial office just three weeks after being discharged. She also started to receive calls from debt collectors harassing her about when she would pay her hospital bills. Her DPC doctor told her to apply for Ascension’s charity care program before paying her bill. “I didn’t know what he was talking about,” Ms. Evans said, “When I asked if there was any financial assistance available, the hospital administrators told me it was too late for me to apply.”
The staff at Texas Direct Medical Care started calling Ascension two months after Ms. Evans’ surgery to find the department responsible for administering Ascension’s charity care program. Finally, they found an administrator that gave them instructions on how to apply. Ascension’s instructions: call a phone number, leave a message on an answering machine with her name and address. Upon review Ascension would then mail the patient a paper copy of their charity care application.
More than eight months later, she has still not received an application after leaving a voicemail with her information. Ms. Evans is still sitting in limbo wondering if she will need to pay $60,000 or if she will be finally deemed eligible for charity care.
And when it comes to applying for charity care, Ms. Evans’ story is just one of many. Recent polling done by WPA Intelligence shows that 87% of Texans are unaware that non-profit hospitals are required to offer a financial assistance program. Uninsured, underinsured, and low-income Texans who make less than 400% of the federal poverty level are eligible to have their entire cost of care covered or heavily discounted by non-profit hospitals.
In exchange for providing this benefit, commonly referred to as charity care, non-profit hospitals are exempt from state and federal taxes. Charity care, historically, is supposed to be regarded as the first line of defense in America’s public safety net for health care related costs. Ideally, charity care is intended to be made accessible to patients who are one medical bill away from being on Medicaid, or having to take a second mortgage on their house to pay for medical bills.
Texas is one of five states that has minimum spending requirements for charity care. Even with these requirements, experiences like Ms. Evans are sadly common across the Lone Star State.
Having cracks within charity care oversight could be disastrous for the state. Texas already has the unfortunate distinction of possessing the nation’s highest uninsured rate with roughly 5 million Texans being uninsured. Currently, 9.3 million Texans have incomes below 200% of the federal poverty level. In other words, three out of ten Texans qualify for charity care based on income alone.
From 2019-2021, more than 1 in 10 Texans reported having medical debt, which is above the national average of 8.6%. Furthermore, of the 20 most populous counties in the country, none of them have a higher concentration of medical debt than Tarrant County and Dallas county. Medical debt is a significant burden for Texans and can be an unexpected debt that can lead to financial ruin.
Texas can lead the way with three reforms that would ensure patients like Ms. Evans will not be wrongfully dismissed and forwarded to debt collectors.
First, Texas should require all non-profit hospitals to pre-screen patients to see if they are eligible for their charity care program before they can send them to debt collections.
Second, shortening the processing time of charity care applications would allow for a more streamlined process that ensures patients get the care they need without having to unnecessarily wait.
Third, Texas should require the charity care obligation across the entire non-profit system, which would ensure that every patient regardless of geographic location would be ensured access to charity care.
No charity care eligible patient should fall through the cracks and fall into the abyss of medical debt. To end patient stories like Ms. Evans from happening again, Texas should reform its charity care requirements to ensure patients get the financial help they need.