Many US hospitals employ aggressive tactics to collect medical debt. They are flooding the district court with collection suits. They garnish the patient’s wages.they withhold a tax refund.
But wealthy Midwestern nonprofit health systems have gone a step further, withholding treatment from unpaid patients.
Alina Health System, which operates more than 100 hospitals and clinics in Minnesota and Wisconsin and generates $4 billion in revenue a year, has said it has a large sum of money, according to internal documents and interviews with doctors, nurses and patients. It is said that he sometimes refuses a patient who has a lot of debt.
Alina’s hospital will treat anyone in its emergency room, but other services may be cut off for indebted patients, including children and those with chronic conditions such as diabetes and depression. The patient is not allowed to return until the debt has been paid in full.
Non-profit hospitals like Alina receive huge tax breaks in exchange for providing care to the poorest people in the area. But last year’s New York Times survey found that nonprofits have failed in their philanthropic missions for decades, with little to no results.
Alina has a clear policy of terminating patients who owe money for services received in the health system’s 90 clinics. A 12-page document seen by The Times instructs Alina staff how to cancel appointments for patients with outstanding debts of at least $4,500. This policy describes how electronic medical records can be locked so that staff cannot schedule future appointments.
“These patients are the poorest patients with the most serious medical problems. They are the ones who need our care the most,” said Matt Hoffman, a primary care physician at Alina in Budnais Heights, Minnesota. ‘ said.
Alina Health said it has a strong financial assistance program that helps pay for more than 12,000 of its 1.9 million patients each year. The hospital system will terminate patients only if they have outstanding debts of at least $1,500 or more in three installments. Hospital spokeswoman Connie Bergerson said the hospital has been contacting patients with repeated phone calls and letters containing information about applying for financial assistance.
“Alina Health’s goal is and will continue to be to have zero patients financially out of service,” Bergerson said. He said outages are “rare,” but declined to provide information on how often they occur.
Alina suspended its patient isolation policy in March 2020 when the coronavirus pandemic began, but resumed in April 2021.
Estimate 100 million Americans have medical debt. Their bills account for about half of the country’s outstanding debt.
About 20% of hospitals nationwide have debt collection policies that allow treatment to be canceled, according to the report. investigation Article last year by KFF Health News. Many of them are non-profit organizations. The government does not track how often hospitals withhold treatment.
Under federal law, hospitals are required to treat everyone who comes to the emergency room, regardless of their ability to pay. However, the law (called the Emergency Medical Labor Act) does not say how the health system should treat patients who need other types of critical care, such as those with advanced cancer or diabetes. not.
Alina avoided about $266 million in state, local and federal taxes in 2020 thanks to her nonprofit status, according to the Loan Institute, a health care think tank.
In return, the Internal Revenue Service is asking Alina and thousands of other nonprofit hospital systems to provide benefits to their communities, such as providing free or low-cost care to low-income patients. increase.
Federal regulations, however, do not specify how poor a patient must be to qualify for free care. One study found that Alina spent less than half of every 1 percent on charity care in 2020, well below the national average of about 2 percent for nonprofit hospitals. analysis Ge Bai, professor of public health at the Johns Hopkins Bloomberg School of Public Health, reporting on the hospital’s financial statements.
Allina is one of Minnesota’s largest healthcare systems and has grown primarily through acquisitions. Since 2013, annual profits range from his $30 million to his $380 million. Last year was the first loss in a decade, largely due to investment losses.
Economic success has paid off.Alina’s president earned $3.5 million in 2021, the most recent year for which data are available. The health system recently built a $12 million conference center.
However, Alina can sometimes be harsh with her patients. Physicians are accustomed to seeing messages in their electronic medical records informing them that patients will be “disqualified for treatment” because of “unpaid medical balances.”
Rita Laverty, M.D., a primary care physician who works at Alina’s clinic, said the notice was alarming as it meant the inability to provide continued care for some patients who face many health risks. said that.
“Nobody wins if patients don’t get preventive care,” Dr. Laverty said. “If not detected early, the outcome of the disease is much worse.”
Doctors and patients said they were unable to fill out the medical forms required for children to enroll in nurseries or present proof of vaccination at school.
Celina Gragart, who worked as a scheduler at the Alina Clinic in Minneapolis until 2021, said the computer system wouldn’t allow future appointments for some patients with outstanding balances.
Gragart and other Alina employees said some of the patients who were kicked out had low enough incomes to qualify for Medicaid, the federal government’s insurance program for the poor. .It also means these patients are eligible for free treatment under Alina’s own financial support. policy — Many patients may not be aware of its presence when seeking treatment.
Alina spokeswoman Bergerson did not dispute this, but said the healthcare system “does great efforts to support patients’ financial obligations to care.”
Alina employees said the policy forced them to distribute care.
Pediatric nurse Beth Ganhas recalled a case in which a mother brought in three children. One had scabies, an intensely itchy skin disease caused by an infestation of mites.she wanted to follow best practices He then treated an entire family, who shared a bed in one rented room, to prevent further spread of the infection. However, it was only her two of her children that she was able to write her prescriptions for. Her third account was locked for nonpayment.
“There are many better ways to save money than what we do,” Ganhas said.
Alina says the policy applies only to liabilities related to care provided by clinics, not hospitals. However, patients said in interviews that they were saddled with debt and terminated for the services they received at Alina’s hospital.
Alina is a dominant healthcare system in some rural Minnesota, so being kicked out could leave patients with few options.
Jennifer Blade lives in Isanti, a small town outside Minneapolis, and Alina owns the only hospital there. Braid, a mechanic, spent two weeks in Alina’s Mercy Hospital in 2009 for complications from pneumonia and saved nearly $200,000 in bills after several emergency department visits for asthma flare-ups. said. Ms Blyde, the mother of her four children, said most of her hospital stay was not covered by health insurance and was unable to scrape together enough money to pay off her debts. .
Last year, Bride said she had a cancer scare and was unable to get an appointment with a doctor at Mercy Hospital. She had to drive over an hour to get tested at a medical facility unrelated to Alina.
Alina does not make this policy explicit to her patients.that is not stated You can find it in our list of Frequently Asked Questions about how to bill your healthcare system. In at least one case Alina denied it even existed.
In a lawsuit filed in Minnesota state court last year, Alina sued Jordan and Jolinda Anderson for nearly $10,000 in unpaid medical bills.
In court filings, the couple stated that Alina had canceled Anderson’s appointment and that no new appointments would be made until she had three separate payment plans — one for the health care plan and two for debt collectors. I explained why I was told I couldn’t do it.
Canceled appointments were not restored even after setting up a payment plan totaling $580 per month. Alina allows reinstatement only if the patient has paid the debt in full.
Anderson recalls being devastated by not being able to see an endocrinologist who specializes in her chronic illness. She had already waited four months to get her appointment, but she couldn’t get another one.
“I felt like I was being punished, and the punishment was that you had to stay sick,” she said.
Bergerson declined to comment on these cases, citing patient privacy.
When the Andersons asked in court for a copy of Alina’s policy prohibiting unpaid bills, the hospital’s attorney replied: unpaid debt. “
In fact, Allina’s policy, written in 2006, tells employees just how to do it. Among other things, it instructs staff to “cancel all future clinic appointments scheduled by patients.”
We offer several ways for patients to continue their care despite non-payment of fees. One is to get loan approval through the hospital. Another way is to file for bankruptcy.
Susan C. Beachy Contributed to research.
