An open letter to Mass General: Don’t screw with mom

OK, I’m going to drop the professional veil here — or breach the fourth wall, if you prefer a theatrical metaphor — and share the tale of how my mom got stuck with a $25K hospital bill. Then I’ll tell you why you should care.

First, feel free to assume that my mom, while rich in spirit, isn’t much of a financial high-roller. Like most Americans, she knows little about how health plans or hospitals operate, despite being a very intelligent lady.  And while she’s hell on wheels when it comes to advocating for my special-needs brother, I’m sure she finds it harder to fight tooth and nail for herself, especially given that she has very little idea of how to start.

Now comes the part that makes me want to rip my flesh with my bare hands.

My mom recently got vital medical treatments at a hospital in the Boston metro (ahem, Mass General — did I say that?), which were going to be paid for by her health plan.

Since then, however, she has been told by the hospital’s so-called “financial counselor” that a) Allstate wouldn’t pay for the treatments (unknown to her, because no one from the hospital’s staff warned her!) and  b) despite having a miniscule income, she didn’t qualify for some assistance program the state offers, which meant that Allstate’s gain was her loss.

OK, let me get this straight. The hospital’s staff fails to verify her coverage for a very expensive treatment (something that may not be a legal obligation, but certainly seems like common sense and ethically appropriate for both parties).  They fail to tell her that the coverage fell through and give her at least a choice about proceeding or not.  They proceed to bill a low-income grandmother $25K for the procedure — and never ONCE suggest to her that as a non-profit, they have, let us say, a few obligations in the “helping patients” department.

Why should you care about my family’s travails?  Well, for one thing, it points up a sad reality — that despite high-profile lawsuits spanking hospitals for behaving this way, and a growing flood of state laws demanding sliding scales for uninsured patients, that top-ranked hospitals still pull this crap whenever a regulator’s back is turned.  It’s more than cruel; it’s foolish in the extreme.

With our good friend Chuck Grassley still campaining for minimum charity spending by hospitals (last quote I heard was that he’d like to see 5% of gross revenues dedicated to charity care), it doesn’t make a whole lot of freaking sense to put a target on your facility’s front door.  Expect Congressional and state paintballs to smack the heck out of that target, and soon.

Oh, and there’s the small matter of what could be construed as, oh, fakery in the first degree.  Mass General bills my mom for a service she could never, ever afford in the first place, then almost certainly writes it off as charity expense — while continuing to press my mom for blood from a stone.  See, we’re so charitable, IRS, aren’t we?  Yes, I know that this tactic has been decried for decades, but I’d argue the time has come to call a halt on it for good.  Hey, the health plans’ shenanigans are in the news today, but you could be next.

The bottom line, honestly, is I’m just plain pissed — not just for my mom, but struggling people everywhere in the U.S..  Dammit, this just shouldn’t happen!  But at the same time, I’m professionally offended by this kind of behavior.  Shame on you, Mass General. I hope somebody there makes this right — and makes plans to clean up their act — or I’m going to be all over them like a bad haircut.  Just see if I don’t.

9 responses to “An open letter to Mass General: Don’t screw with mom

  1. Wow! I work for a charity children’s mental health hospital in Texas. I would quit if that was the way we do business! This should be considered fraud at least for writting something off as charity and then collecting the debt too. Besides from what I understand there needs to an intent frm the get go to claim something as charity, not just simply a bad debt. Tougher charity laws for hospitals and other charities should help this.. I hpe!

  2. Kathy, thanks for your thoughts. Actually, I’m not sure whether hospitals *must* know in advance whether they’re delivering charity care or writing off bad debt. Either way, I’m pretty confident that issue won’t be in play much longer if legislative trends continue.

    My take as a human being is that for those to whom much is given, much is expected. If you’re a Harvard affiliated hospital with access to the world’s greatest minds, and you enjoy a tax-exemption, who are you to trample upon the little guy/woman? (But hey, maybe I’m not cynical enough to be in this biz.)

  3. What a nightmare. So, I’m assuming that your mother is not covered by Medicare. I’m wondering if the reason for the denial is lack of pre-authorization. Usually the attending physician’s office or the hospital preadmissions department does this before anything surgical is done, because they have the patients technical and diagnostic information. If the hospital and doctor were in network with whatever coverage your mom has, part of their contractual obligation would be to get it authorized. Usually, when a facility balance bills a patient for full charges, they have to have a “waiver” signed by the patient acknowledging the non-coverage. Good luck.

  4. I do indeed think the reason for the denial is lack of pre-authorization — I doubt she would have gone anywhere or agreed to anything assuming she’d have to pay — but I can’t get to the bottom of the matter.

    The line I’ve gotten from MGH so far is that they can’t share information because of HIPAA. And that was from the PR department, which I’d called to ask for comment, not any administrator. (On the PR end, they had not a word to say, despite two requests.)

    You know what, the idea that there’s no way for MGH to let me help my mom is nonsense. While Imay be true that they can’t share data related to treatment, I’m pretty confident my mother could (and wishes to) waive those rights and give me access in about 30 seconds.

    So, is anyone reading thinking that MGH is acting in good faith here?

    I challenge *anyone* from the senior management at MGH to address these concerns, not just to help my mother but all of those similarly situated. Does no one there care to ensure to see that patients can expect fair, ethical, non-coercive treatment there?

    -Anne

  5. The institution is citing HIPPA as a stalling measure. If they were on the up-and-up they would have told you that your mom can fill out a very simple form that will allow you access to her medical records. Once that is done they cannot legally deny you access to her chart and they must give you whatever information you ask for. Go and get them!

    • Michelle: Thank you for your input. Rest assured, I realize that something isn’t right here — and I’ll stay on this until hell freezes over, not just for my mom but for all others like her. Again, Mass General, if anyone from that institution is listening, have you no concern whatsoever for fairness, patient dignity or helping people resolve their problems? Shame on whomever’s making this more difficult for the medically underserved and indigent. Prove yourself worthy of your otherwise noble mission and *get off it.*

  6. Anne – first and foremost I am sorry to hear about the unfortunate circumstances which incurred by your mother. I work in the medical industry and specialize in the pricing and auditing of hospital bills. It is unfortunate the situation of coverage has come up and how both sides (insurer and provider) are not working together to get this resolved. Many Americans (including my own family members) have incurred a similar type of issue when dealing with hospital care and treatment. The worse part about it all is that the $25K is just charges – this does not reflect the acutal amount the hospital would get paid. Many hospitals have arrangements with insurers for rates significantly below the charge amounts. It is my opinion the treatment provided to your mother would not have differed regardless of her insurance, coverage, etc. However instead of trying to work with your mother and offer her a reasonable payment plan or rate they are going to bill her for the entire amount.

    There is a social conscience involved in providing healthcare and finance is a component of this. Coming from not-for-profit facility makes this situation even worse (although many hospitals have this designation but do not adhere to the true principals of a not-for-profit).

    I wish you the best of luck with this case and offer my assistance to help with the review and audit of this medical bill free of charge if you so desire.

    • Tony:

      Thank you for your input on this situation. The fact that the $25K I describe is just off the chargemaster — and is likely to be far more than an insurance company would pay — makes the situation even more concerning. My hope is to not only straighten out my mother’s issue, but also to pressure MGH to be more transparent about its charity care policies and more assertive about hooking patients up to MGH charity resources. I’ve yet to connect with anyone there as of yet but I’ll report back when I do so. In the mean time, thank you for your offer of assistance…it’s most appreciated!

      — Anne

  7. Pingback: Financial shenanigans and their impact on moms | Go HealthReform

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