Here's what patients are telling helpline
They're often uninformed
While state and federal law require that non-profit hospitals provide individuals with notice of the availability of free care, patients are often unaware, and not all hospitals are compliant or consistent, says Mia Poliquin Pross, Esq., associate director of Consumers for Affordable Health Care (CAHC) in Augusta, ME.
As Maine's Consumer Assistance Program, CAHC operates a statewide toll-free HelpLine that answers 2,000 to 3,000 calls per year from consumers needing assistance with healthcare coverage or costs.
"We often provide consumers with information about hospital free care," says Pross. "It is clear to us that many hospitals go above and beyond the law, to provide financial assistance to individuals with income higher than the law requires, and provide services beyond the emergency department."
However, Pross says these are areas of concern, based on what patients say during the phone calls:
Hospitals don't always inform patients about free care availability.
It is quite common for HelpLine callers who have received services at a hospital to be unaware of the availability of free care, says Pross. In such cases, CAHC coaches them on how to contact the hospital and start the application process.
Patients might be denied free care incorrectly.
Patients sometimes aren't offered a fair hearing and aren't informed of the process. "CAHC provides consent forms to callers who have been incorrectly denied free care and intervenes on their behalf," she says.
There is no clear, consistent way for patients to access information about free care.
To provide accurate and targeted assistance to HelpLine callers, CAHC annually updates information on each hospital's income guidelines for free and sliding scale care in Maine. (To view the information on 2012 Income Guidelines for Hospitals, go to http://bit.ly/T1yRHL.)
In phoning each hospital, CAHC followed the procedure that a consumer would most likely undertake. "The general phone number was called, and we requested to speak with either the billing office, a patient advocate, or someone who could speak to us about hospital free care," says Pross. Some hospital staff members indicated that there was no such program.
"In addition, when CAHC was able to speak with hospital staff whose job it was to screen for such programs, it was clear that some were unaware of the regulations, what the federal poverty level [FPL] is, and/or that they were utilizing out-of-date FPL numbers," Pross reports.
Patient access staff must be aware that the FPL changes almost every year, she advises. [To view the 2012 U.S. Department of Health and Human Services (HHS) Poverty Guidelines, go to http://1.usa.gov/wBQemo. To sign up for email updates from HHS, go to http://1.usa.gov/TTZCCx and click on "HHS Office of the Secretary."] "Free care policies need to be updated as soon as possible, so patients aren't incorrectly denied free care," Pross says.