Mum’s the Word 

Are Missoula’s poor informed about charitable care?

When 19-year-old Missoula resident Crystal Palmer was admitted to Community Medical Center on April 9, 1998 to deliver her son, it took her less than 20 hours to rack up a medical bill totaling more than $4,000. Although her son’s hospital stay was covered by Medicaid, Palmer was unemployed and says the hospital refused to honor her out-of-state insurance coverage.

Despite informing the hospital’s billing department of her unemployment status, over the ensuing months Palmer began receiving bill after bill threatening her with legal action. She says that the bills eventually destroyed her credit rating, making it impossible for her to get long distance service on her phone or finance a car, which, in turn increased her difficulty in finding a job.

“$4,000 is a hell of a lot of money,” says Palmer. “When I asked them about charity care, I got the cold shoulder pretty much from most of the hospitals in Missoula.”

Palmer’s case is neither unique nor extreme, but just one example of how Montana’s hospitals are failing to provide low and moderate income patients with adequate and timely information on the charitable care options they offer.

Or so says a report released Tuesday titled, “Not Making the Grade: Montana Nonprofit Hospitals Fail in Their Charity Care Mission,” conducted by a coalition of five community organizations in the Northwest, including Montana People’s Action. That report surveyed 35 nonprofit hospitals including eight in Montana and both St. Patrick Hospital and Community Medical Center in Missoula.

The study found that when people called the hospital asking for written information mailed to them on charity care options, at least 77 percent of the time that request was refused, and nearly half of the hospitals surveyed had no written information to provide on charity care options.

The study also found that 83 percent of the callers who asked for an application for charity care had that request denied as well. Moreover, the report shows that more than half of those hospitals were unable to provide any information at all to Spanish-speaking callers, and one in six hospitals told callers that they did not have charity care programs when they did.

“We feel that the communities in Montana support the nonprofit hospitals through government grants and loans, preferential regulatory treatment [which] has been critical to the survival of these hospitals, so we’re asking that the hospitals provide charitable or free care,” says Scott Moffett of Indian People’s Action, which participated in the survey.

All eight hospitals in Montana received failing grades, with both Community and St. Pat’s receiving an “F,” based on their inability or unwillingness to communicate with potential patients seeking charitable care information. “Obviously, this is a communication issue,” says Community Medical Center President Grant Winn. “What I’m hearing here is that people are coming to the hospital and are not getting the information that they need with regard to charity care.”

As Winn points out, last year Community Medical Center provided more than $400,000 in free care directly to patients who were unable to pay for it. He says his hospital will write off more than $15 million of its $70 million in medical expenses this year alone, which include charity care, bad debts, Medicare contractual allowances, and so on.

“We do have a [charitable care] policy, and I’m sorry that when you came to do your surveys that they didn’t tell you that,” Winn told Moffett. “We’re going to make sure that our people are prepared to do that.”

Winn adds that Community is required not only by its own policies but by law to have patient fill out a verifiable financial statement about how they intend to pay for their treatment. He says that if it is determined that a patient is indigent, he or she is classified for indigent care and provided health care without cost.

“But any person who comes into this hospital and is indigent and needs care, we don’t do a wallet check before we start providing the care,” says Winn.

St. Patrick Hospital President Larry White was unavailable for comment, but according to Joyce Dombrouski, the hospital’s director of Planning and Communications, White has received the report but has not had an opportunity to read it. However, she did say that St. Pat’s provided about $1.8 million in charity care in 1998, and an estimated $2.7 million in 1999. She couldn’t say what percentage of their total revenue those figures represent, nor whether St. Pat’s provides written information on charity care to patients who request it.

The report’s findings are especially problematic in Montana, where an estimated 12 to 16 percent of all residents have no form of health care coverage. An additional 12 to 16 percent of all Montanans are underinsured, with health plans that do not pay for primary, preventative or catastrophic care.

It should be noted that this week’s report makes no mention of the quality of medical care provided, but simply addresses the issue of access to charity care payment options. The report recommends that hospitals meet with the groups issuing the report to discuss ways of improving how they disseminate information on charitable care, and to push for further investigations into whether hospitals are meeting federal guidelines on serving non-English speaking patients.

Following Tuesday’s press conference, Winn agreed to meet with Palmer to discuss ways of dealing with her medical bills.

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