The Daily - Why So Many Hospitals Are Suing Their Patients

Episode Date: December 2, 2019

For decades, hospitals could assume that patients with jobs and health insurance would pay their medical bills. That’s no longer the case. We speak to one woman about her skyrocketing medical costs — and the aggressive new way hospitals are forcing patients to pay up. Guest: Sarah Kliff, an investigative reporter covering health care for The New York Times, speaks with Amanda Sturgill, 41, whose health care provider took her to court in Virginia. For more information on today’s episode, visit nytimes.com/thedaily. Background reading:One in four Americans have skipped medical treatment because of the cost, and nearly half fear bankruptcy in the event of a health emergency. Meet some of the employed and insured Americans who cannot afford health care.The American health care system is not the norm for developed countries. Here’s a look at how socialized and privatized systems compare internationally.Why doesn’t the United States have universal health care? The 1619 Project found that the answer is linked to segregation.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. For decades, hospitals could assume that patients with jobs and health insurance would pay their medical bills. Sarah Cliff on why that's no longer the case Sarah Cliff on why that's no longer the case and the aggressive new way that hospitals are forcing those patients to pay up. It's Monday, December 2nd.

Hi, Amanda. Hi. It's been a while. It has been. Hi. Sarah, tell me about Amanda Sturgill. So Amanda is 41 years old. She lives in this tiny little town in rural Virginia called Norton. It's very small.

I don't even know why it's called a city because it's not very big. She has four children. She's a single mom. Sarah Cliff writes about health care for The Times. She works full time at an audio equipment company where she processes orders. So it's just kind of like a little freak thing that happened. And a few years ago, her daughter Michaela was giving one of the other kids a bath. And she bent down to pick her up to get her out of the bathtub. She bent down to pick up her sibling and just got this terrible pain in her back. Kind of go down her legs. And she was just in this horrible, excruciating pain. Took her to the emergency room. Amanda obviously is worried.

She doesn't understand what's going on. So she takes her daughter to the emergency room at the local hospital system, a company named Ballad. They give her a pain shot, go back home, but this pain doesn't go away. I went back to the pediatrician. It was probably weekly with Michaela to tell them this is not getting any better. They start seeing specialists and doctors. There are MRIs.

There are more pain shots. And no one can really figure out what's going on with Michaela. And the pain is getting worse. She's just like, something's not right. I'm in really bad pain. She can't walk without pain. She's having trouble sleeping.

And Amanda's like, oh my gosh, is my teenage daughter going to have to live with this terrible pain for the rest of her life? So what happens? So it came back on the MRI. There was a slight bulge down there. They figure out that Michaela has a degenerative disc disease. He's like, your daughter's back is the back of a 70-year-old woman. So it's serious. And a doctor recommends that the best course of action is surgery. When you found out Michaela needed surgery, kind of what was going through your mind?

Oh, I was terrified. Terrified of thinking your young child is going to have to go through this excruciating surgery. And were you worried about money at all when you found out about the surgery? No. I honestly, I didn't care. I was like, I don't care. You run whatever test you run, I will deal with the bills when they come. I was like, just, you know, help her get her better. So the surgery happens. It goes decently well. It doesn't fully relieve Michaela's pain. So that issue still lingers. But they go home and then the bills start showing up. It was just one of those days where, you know, just go check the mail,

go walk out to the end of the road. And we get a couple bills that were about $200 here and there. They trickle in because remember, there have been all these doctor appointments, all these specialists and MRIs and shots. So there's a few that are like 50 something, 100 there, 200 here. But then the bills get bigger. Ended up owing like 500 and some dollars per MRI and then the surgeon. The surgery bill comes and that's over $2,000. Wow. And I was like, oh, wow, hello. I wasn't expecting that. For Amanda, you know, she earns $12.70 per hour at her job. This is a really significant bill and she just does not have the money to pay it. And does Amanda have insurance? She does, yeah. She has insurance at work. She felt like it was good insurance. But then she's finding that her insurance actually expects her to pay

a lot of co-pays, a certain share of the surgery, and it's starting to get pretty stressful. It's like, well, let's just start from what we can and what we can't do. So I just started filling some out and sending them. But there's so many. She really wants to pay the bills. I pretty much clinch every penny I possibly can. And what is going through your mind about these bills as they're piling up? I will go to flea markets, have yard sales, that sort of thing. She's trying to scrape together the money. I will sometimes not eat, but like once a day to try

to save money so I don't have to buy food and just save it all for them. We'll have dinner together and they see me do that, but they have no idea that I do that during the day. But then during the entire day, you don't eat to save money. Right, right, right. How do you feel by the end of the day? I know you work a full-time job. How do you feel by the end of the day? I know you work a full-time job. I get pretty emotional sometimes.

You know, I'll go and cry and hide in the bathroom and then just, you know, come out and be the happy mom that I need to be to make sure that their life is as normal as possible. I don't let them know any of this. So for a while, this works, and she's able to keep up with the bills. She's sending in payments to the hospital. But a few months ago, she falls behind.

She just isn't able to come up with the payments that she's supposed to be making on these bills. And then one day, there's a knock at the door. It was about midday. The kids were home. And the dogs start barking. The kids were like, Mom, there's a cop on our porch. And I was like, oh, OK. So I went out there.

He was in his brown sheriff's uniform. He had his sheriff car that had the lights and the sheriff stickers all over it. And he has a document that he needs to give Amanda. You know, we've got this summons to court. And I was like, wow, okay. So Amanda takes the documents. You know, I just, I said, thanks for bringing it to me. So I ended up having to...

She tells the kids, don't worry, it's just some important papers that they couldn't deliver in the mail. You know, just so they wouldn't like freak out. Then she actually opens it up and it turns out that the hospital is suing her for the medical debt that she owes them. And this is a court warrant with a court date that they're asking her to attend. I was very shocked and scared because then I'm just like, oh, my gosh, I don't know what to do.

Oh my gosh, I don't know what to do. So she has fallen behind on this bill, and the hospital is now taking her to court over this unpaid bill. Exactly. And things have moved from the billing department into the courtroom. Amanda has a court date. June the 27th. But it turns out her court date is actually a day she has an appointment. I had to go to get checked because I had a lump in my breast. So we had to go and get

that checked out. And I wasn't missing that for nothing because it took me. She had recently found a lump in her breast and it had taken her weeks to schedule a mammogram. And where did you have that doctor's appointment? It was in Ballard. It's one of their physicians. And how did that turn out? Is everything okay with the lump that they found? Yes. Okay, good. Yes, yes. Glad to hear that.

It was just a benign little tumor thing. So, but yeah, it's good. So you were going to get healthcare from the same provider that was suing you over your medical bills on the same day? Yeah, because we have nothing else. We have no other options. provider that was suing you over your medical bills on the same day? Yeah, because we have nothing else. We have no other options. You know, it really makes you feel uncomfortable because it's like when you go, it's like, do they know that, you know, Ballard is suing me over this? Are they going to say something to me? ballot is suing me over this. Are they going to say something to me? Are they going to deny me health care because I owe them money? It was pretty terrifying. Sarah, nothing about this sounds normal. A mother with a solid job and health insurance suddenly has a sheriff at her door and she faces legal action over falling behind on a medical bill.

It is actually becoming surprisingly common in our healthcare system. There are thousands of Americans, many with private insurance, currently being sued by their hospitals. They're in big cities, they're in small towns. And the reason I know this is actually the story of how I found Amanda. We'll be right back. Okay, Sarah, you said that finding Amanda helped you understand how widespread this problem was. So how did you find Amanda? I found Amanda a few months ago when I went to this tiny little courtroom in rural Virginia, about six hours west of Washington, D.C., where I live. And on the day I went to court, there were 160 cases on the docket. 102 of those cases were being brought by

the local hospital system, Ballad. In each of those cases, the hospital was suing one of its patients for outstanding medical debt. And Amanda was one of the 102 cases that would be hurt that day. So what's happening here? Why is the local hospital suing over 100 of its patients? Yeah, so that's something I started to figure out talking to the people who are in the courtroom and calling people who weren't in the courtroom. It turns out most patients actually didn't show up to their court date. And what I found out is a lot of these people had health insurance. There was a school teacher, a correctional officer, even a woman who worked at the hospital who had private insurance but were responsible for shares of their bills that they just felt like they couldn't pay.

And now Ballard was turning to the courts to recoup the money that they were owed. Why is that the case? Why are people with jobs and insurance falling behind on their payments and now being sued? So in order to understand that, I think you need to zoom out from the courtroom and look at a big change that has been happening in our health care system over the past decade or so. What I see in my reporting is patients consistently being asked to spend more and more of their own money on health care, even when they have insurance. A really perfect example of this is deductibles. That's the amount that a patient has to pay before their insurance will start kicking in and covering their doctor visits and their hospital trips.

If you look back to like 2006 or so, only about half of people who had insurance even had a deductible. They weren't that common. You flash forward to this year and 82% of people who get insurance at work now have a deductible. The size of the average deductible has about tripled between 2006 and 2018. It used to be about $600. Now it's about $1,700. So you have this moment when healthcare prices are going up and up and up, and patients are being asked to pay for it and pay more through deductibles, through copayments. And why is that? Why are so many of these plans now asking people to pay such a high deductible?

It mostly comes down to the fact that health care prices are growing really quickly. And if you're an employer, if you're an HR department, you have a few ways to deal with this. You could increase your employees' premiums. That's the amount they pay each month. Or you could keep premiums constant and just ask people to pay more when they go to the doctor. A lot of companies have found that the latter option is the way they want to go. So that's how employers deal with this problem of rising costs. But then you have someone like Amanda, who does have to go to the doctor a lot for her daughter and ends up with this bill she can't afford.

And you have the hospital on the other end of this who is watching hundreds of Amandas in their system all of a sudden not being able to pay the bills that the insurance company typically was taking care of. Got it. And when a person can't pay that bill, now the hospital is suddenly on the hook. So it's like cascading through the system. Exactly. And hospital executives, when they see someone who comes in with insurance, they're thinking, okay, this is someone who could pay their bills. They have the backing of an insurance company. But that's not really the case. You have this whole new bucket of patients that hospital executives aren't really sure how to deal with.

Some are dealing with it by coming up with financial assistance for those people. Others are dealing with it by going to court to try and collect the debt that insurance companies used to pay them. So what do hospitals like Ballard say about why they're making this decision to sue their patients? They say that, look, we're a business. We have to stay open. We have to stay afloat. Bayala exists in a pretty rural area, part of Virginia and Tennessee,

and we've seen a lot of rural hospitals closing. They would argue that the financially responsible thing to do is collect the debts that are owed to them. They say that they only pursue patients in court who can afford to pay but have chosen not to pay their medical bills. So people who, in their minds, if they prioritized paying back these bills and organized their finances around that, they could pay those bills.

Exactly. You know, these are people with jobs, people with insurance. From their perspective, these are people who could pay that debt. And Ballot is serious about collecting that debt. I just feel sometimes like I'm failing my kids, even though I know I'm doing the best that I can for them. And what does someone like Amanda say to that? I know you're making about $13 an hour. You're supporting four kids.

How do you think you got tagged as someone who should be able to make their payments? I honestly have no idea. She does not think she fits that description. How in the world do you all think that I can pay this off? It's like my paycheck every couple of weeks is, I think I clear $806. Amanda feels like she's skipping meals and she's selling her things to pay. You know, my mortgage and stuff like that. And there's kids to take care of. It's like I've not paid my water bill yet. I just keep thinking, please don't come turn it off right now.

That sort of thing. And then I've got a payment arrangement with the electric because I got a disconnect notice. So you've been putting off your electric and water to pay the health bills? Yeah, yeah. Because I don't want to, you know, be took to jail if that's what they would do or whatever. or whatever. You've said that this is becoming more common, but just how common is this kind of a lawsuit now?

So what's happening at Ballad is pretty representative of a trend we're seeing across the country. If you look at Ballad's lawsuit volume, they've been suing patients for a while, but back in 2010, it was about 3,600 lawsuits a year in the court records I examined. Flash forward 2018, there's over 6,700 lawsuits. So double.

Doubled in less than a decade. You look at other hospitals. Children's in Wisconsin is a good example. This is a nonprofit pediatric hospital. They've sued more than 1,000 patients since the start of 2018. And that's more lawsuits in two years than the entire decade prior. Johns Hopkins University in Baltimore, New York Presbyterian in Manhattan. They still have pretty low lawsuit volume, but it's going up.

And is it ever the case that a company like Ballad sues a patient, the patient pays, and it all resolves itself? Definitely. So hospitals are finding that the courts are a pretty good way to collect money for a few reasons. The first is that patients typically don't show up to their court date. That means as long as the hospital sends a lawyer, they're going to win the case because the other party didn't show up. Once the hospital wins the case, they have the rights to start garnishing their patients' wages. You can get a lien on their property. You could even arrest them.

It gives the hospital a lot of power working through the court system. So how does Amanda's case end up playing out in court? So she doesn't go to the first court date. I had previously contacted them to let them know that I wasn't going to be there. There's a second court date that she said she never heard about where the hospital does get judgment against her. But her wages have not been garnished. She ended up setting up a $150 a month payment plan. And have you been able to make the payment each month?

I have up until this past month. I was really trying to. It's just hard. Every time my phone would ring, I'd say, please don't be ballad calling me. Please don't be ballad. So what happens once she starts falling behind in these payments? So she's nervous. She's worried, you know,

there's this court warrant out for me. Could they throw me in jail? And she sees that the hospital is calling her. I was terrified to answer it because I hadn't made the payment. I was scared to death. So I let it go to voicemail, but then I called her back and I was scared to death. So I let it go to voicemail. But then I called her back and I was like, hey, it's Amanda.

What do you need? And the person on the other end of the phone says, we're just calling to tell you. We had an anonymous donor that paid off your warrant, which was like $2,200 is what it was final down to. Somebody paid your medical bill. You don't have to make payments anymore. I was shocked. I said, are you sure? You know, can you just recheck?

And she goes, no. She said, it is. She said, we are writing it. We're doing all the stuff to get it taken care of. And it's paid off. And it was such a relief. And I was like, you can't tell me who did it so I can thank them. And she's like, no.

I was like, well, so what had happened here? So what happened was I ended up writing about Amanda's story in the New York Times. And between that story running and that phone call, story in the New York Times. And between that story running and that phone call, an anonymous donor read about the story, called Ballad, and offered to pay off Amanda's bills. So she is now without debt from this back problem that her daughter had. She's kind of scot-free. Well, sort of. So how much do you still owe to Ballad right now? Um, I've got Apollo bills.

It's about $5,400 and some dollars. Then I know I'm paying on another one, which is like $1,000. My ex has a couple that he's paying on that I just could not do. So, yeah, I mean, it's a lot. It's a lot. Sarah, what do you make of what happened to Amanda? I think it shows you something really problematic about the current state of American health insurance. When you think of even the concept of insurance, it's supposed to mean protection.

It's supposed to mean you have someone else who's going to pay your medical bills no matter how high they get. We spend a lot of time talking about the people who don't have a health insurance, about 30 million or so Americans at this point. about 30 million or so Americans at this point. But you also have this class of people who you could think of as underinsured, who are paying premiums, who are buying some kind of product that they think of as insurance. But then when they actually have to use a lot of health care, they're finding that it's not really protecting them in the way that they expected to be protected. It's not like I'm out here trying to live this lavish life and I'm just wanting to forget these doctor bills. You know, I don't need to pay them for a hospital.

It's not that. I don't have the means to pay it. What else could I have done? What else could I have done different? Let's say you were in charge of health insurance in the United States. How do you think it should work for someone like you? Oh, goodness. I've thought about this so many times, and it's so weird that you asked me this. I just feel like we're the United States. We should come together and take care of each other. We should come together and take care of each other. I would love to see people be healthier and just not have to worry. Everybody can go to the doctor without being afraid to go.

Okay, Siri, right now we're in the middle of a national debate about those very questions, the future of American healthcare. And the concept that is most widely debated in the context of the presidential election is Medicare for all, is the United States government taking on healthcare and eliminating the kind of private insurance that someone like Amanda has. If such a system were created, how would it address the issues that you have discovered in your reporting? The system being proposed now in the presidential primary would get rid of deductibles. There'd be no premiums. There'd be no copayments. When you went to the doctor, you would not pay a single penny. But the money has to come from somewhere, right? You need a lot of those anonymous donors

who paid off Amanda's bill to be financing such a system. So you'd need to have a big shift in kind of who's paying for health care. There is going to be a lot of debate around Medicare for All and single payer in the next year. There are a lot of pluses and minuses to that type of system. But what I can certainly say is that if the United States adopted a system like that, I would not have stories like Amanda's to write anymore.

Sarah, thank you very much. Thanks, Michael. We'll be right back. Here's what else you need to know today. They didn't want to do a ceasefire, but now they do want to do a ceasefire, I believe. It'll probably work out that way. During an unannounced trip to Afghanistan, President Trump said that the U.S. would reopen peace talks with the Taliban, aimed at ending the 18-year-old war there.

Trump had abruptly ended the talks in September after the Taliban claimed responsibility for a suicide bombing that killed a U.S. soldier. The Taliban wants to make a deal. We'll see if they make a deal. If they do, they do. And if they don't, they don't. But the president has now

injected confusion into the negotiations by demanding a ceasefire from the Taliban, something U.S. diplomats have never before saw, are unlikely to obtain, and have little power to enforce. And, in a letter, the House Judiciary Committee has given President Trump a deadline of this Friday to decide whether to present a defense or call a witness as the committee considers articles of impeachment against him. The letter lays out a rapid timetable for impeachment in the House. The Judiciary Committee could vote on articles of impeachment by the week of December 9th, and the full House could vote on impeachment by the week of December 9th. And the full House could vote on impeachment

by the week of December 16th. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.