Despite patient advocate asks, HCA's Mission yet to make charity care application public
ASHEVILLE - HCA Healthcare in general and the Mission Health network in Western North Carolina specifically won’t make its charity care application publicly available, and now some organizations and even a state official are prodding the company to be more transparent.
That prodding started with a collaboration between Dollar For — a Portland, Oregon, -based organization that helps people “crush medical debt” by leading them through the labyrinthine world of medical bills — and the Mountain Maladies Facebook group, a 13,500-member forum where people discuss medical matters, treatment, bills and often the shortcomings of Mission after its 2019 purchase by HCA for $1.5 billion, changing it from a nonprofit to a for-profit system.
Dollar For is founded and led by Jared Walker and has a tool at dollarfor.org anyone can use to find out if they qualify for charity care. Mountain Maladies is created and partly administered by Will Overfelt, a vocal patient advocate in the WNC region and one of six plaintiffs in the first WNC antitrust lawsuit against HCA and Mission Hospital.
The two kicked off a relationship following a July 14 patient advocacy forum hosted by advocacy group Take Medicine Back regarding the states certificate of need process and how it relates to a current expansion bid by three hospitals: Mission, AdventHealth and Novant Health.
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At that online forum, Walker presented on each of those three hospital systems’ charity care policies, none of which were outstanding, he said, noting for instance that a patient's bill has to be at least $1,500 before Mission’s charity care policy kicks in.
Charity care, according to the North Carolina Healthcare Association’s definition, is “services provided free of charge or at a substantial discount.”
Each hospital has different policies, and while nonprofits like Novant and AdventHealth are required to offer charity care in order to qualify for tax-exempt status with the federal government, for-profit hospitals like HCA are not.
WNC patient advocates push for application
But HCA-owned Mission Health chooses to provide charity care for patients and though it has a seven-page charity care policy posted online — in English only — what it does not have posted publicly is the application.
This bothered Overfelt who uses his platform to try and make health local care options and research more accessible to group members. It bothered Walker on principle, since his organization’s work effectively hinges on access to charity care information from each hospital.
Walker and Overfelt want to help more people in the seven-hospital Mission Health footprint know more about and apply for charity care, if they need it.
To do this, they want a complete copy of HCA/Mission’s charity care application.
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Walker collaborated with Overfelt to write a letter to Steve Gross with Parallon, which provides billing services for HCA.
“You've been very helpful for many members of our group and we appreciate that. I wanted to reach out to you to ask a question about charity care,” Overfelt wrote Gross Sept. 13. “I have a big ask: We would like to be able to tell the community that HCA made their charity care application (as a PDF or Word document) available to us so that we can help folks complete that form and submit it as quickly as possible.
“We have a pretty good understanding of the HCA policy and could guide folks to the application and help them complete it. It would make our processes flow much smoother and would make charity care much easier to receive, and it would be a bit of goodwill between HCA and the Asheville community.”
Overflet also reached out to N.C. Treasurer Dale Folwell’s office regarding the request.
Folwell has championed better charity care practices in the state, simultaneously condemning “failures” in the system. His office reported in January that some of North Carolina’s hospitals “have billed $149.2 million to poor patients who should have qualified for free or discounted charity care under the hospitals’ own policies in fiscal year 2019.”
More recently his office released another report that found “huge disparities between the Medicare losses claimed by hospital executives and the numbers that hospitals reported to the federal government.”
Folwell also sent a letter to Gross.
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“I wanted to call your attention to the correspondence below that my office received from a stakeholder group of about 13,000 concerned citizens based in Asheville, NC. The group has developed a partnership with a nonprofit organization that seeks to help people complete charity care applications from health care facilities,” Folwell wrote on Oct. 6.
“The group Is asking that HCA Healthcare provide an electronic form that can be completed with the assistance of volunteers from the organization to facilitate applications for charity care under HCA's financial assistance policy . … Their request is common sense and would likely improve the quality of information being provided to HCA Healthcare on charity care application forms. Please consider the possibility that this is a change that HCA Healthcare could adopt to build bridges with the communities it serves.”
A week after Folwell sent his letter, Gross replied to Overfelt.
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“I want to let you know that we are looking at ways to improve the process for our patients,” Gross wrote to Overfelt. “HCA Healthcare’s patient benefit advisors help uninsured and under-insured patients understand and access programs and discounts that can help reduce their financial burden. This process most often starts at the time financial counselors meeting with our patients and their families to help them understand the charity care and financial assistance that may be available.”
Gross ended the email by asking Overfelt to “please allow us some additional time to consider your feedback and suggestions to help streamline our process.”
He did not provide a copy of the application.
In an interview before Gross responded, Overflet laid out his asks.
“I want them to make the application available and I want them to remove some of the steps, particularly the step where you have to call in and get pre-authorized,” he said. “They've got standards for who can get it, and we know what those are. Let people make the application anyway. Don't put extra steps in it.
“And it'd be even nicer if they reached out to people and said, ‘Hey, based on the information we've got, it seems like you qualify for charity care.’ I just want them to not make it so difficult for people who don't have the resources, the intellect, the networking skills. There's a lot of people in this town who work two or three jobs, and (they) don't have time to sit around and make phone calls and beg for the application, just make the application process clear, and make the form accessible to people.”
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Walker echoed these sentiments, explaining the murkiness of the application process, and the online policy information itself inhibits his organization from helping people get charity care.
The Citizen Times also requested the application from Gross, who forwarded the request to HCA/Mission spokesperson Nancy Lindell.
“The Mission Health Charity Care page offers information and a phone number, not for ‘screening,’ but to give patients the opportunity to speak with one of our financial counselors who can help each patient individually navigate their various options to determine what is most helpful. By having conversations with our patients, we try to help them with what most suits their specific needs and to make the process easier.”
While Lindell did not rule out the possibility HCA may make the application public in the future, she reiterated Gross’ point that charity care starts when medical care starts and not before.
“While we are considering the merits of providing the application online, it’s important to note that our financial assistance process starts at the time care begins and we encourage conversations with our financial counselors so that we can help each individual find the assistance that is most helpful to their unique situation,” Lindell said.
She called HCA’s Charity Care Policy “robust” noting it provided a 100% write-off related to emergent, nonelective services for qualifying patients who are not eligible for state or federal assistance.
The hospital system also has what it calls an “Expanded Charity Care Policy” which provides financial relief for emergent, nonelective services to families with annual household incomes between 200% and 400% of (the federal poverty guideline).
The federal poverty guideline in 48 states currently is $26,500 for a household of four or $17,420 for a household of two.
“We also have an Uninsured Discount Program, Patient Liability Protection, Prompt Pay Discount, Interest Free Payment Plans, Medicaid Eligibility Assistance and more," Lindell added. "Our financial counselors are there to help patients navigate these various options, not just fill out an application.”
She said that, since 2019, Mission Health has provided more than $857 million in financial assistance and delivered $100 million more in charity care in 2019 than in 2018.
'The hospital is calling all the shots'
Walker in his presentation at the July 14 Take Medicine Back forum and in a recent interview was critical of HCA’s charity care policy, partially for transparency reasons.
“We have never been able to find an HCA application online,” Walker said, noting different HCA-owned hospitals have different applications.
“Every single time it is so incredibly hard to get their application. The patient must call and be pre-screened to access a copy of the application. And it's absolutely our biggest thing with them. What we're trying to do with that particular hospital is say, ‘Hey, like, give us a freaking copy of your application so we don't have to play this game every single time.’”
Even if Walker and Overfelt did get the application, there still is a possibility HCA wouldn’t accept it because of the pre-screening prerequisite.
The vagueness and bureaucracy-like layers of this process speaks to a much larger, nationwide issue, according to Walker and his organization and numerous other hospital billing transparency advocates like Folwell and PatientRIghtsAdvocate.org, which reported in February that many hospital systems are not complying with federal regulations regarding clear and accessible pricing.
"Our big thing, even our mission statement would be, we are crushing medical bills, by enforcing hospitals’ charity care policies,” Walker said. “We are trying to make charity care known, easy and fair, right? Known is a major, major component: People need to know about it.”
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That "known" factor is for Dollar For is down to awareness campaigns like TikTok videos, one of which launched Walker to national fame and helped create the organization. However, hospitals need to be better about reaching out to patients and informing them of charity care options instead of waiting for patients to find out they are eligible, Walker said.
“So, knowing is problem number one. Then is it easy?” Walker said of charity care access. “And that's where the accessibility part comes in. … I think I can safely say that about 90 to 95% of all hospitals in the country, for-profit or nonprofit, the main way that they will accept your application is through fax. I mean, we probably spend thousands of dollars every month mailing in applications, because some hospitals don't even allow you to fax it.”
Finally he said, the fairness of the charity care process is a major factor.
“At the end of the day, the hospital is calling all the shots,” Walker said. “You can do everything, right, and if they say, ‘Well, we think that you make too much money,’ or ‘We think that you drive too nice of a car,’ they can deny.”
Walker said all these issues play into Dollar For’s interaction with patients who have HCA hospital bills, but improvement has to start with transparency.
“From what I know about HCA … we have never been able to find a (charity care) application online,” he said.
According to data collected by Dollar For and presented in July, 525 people worked with the organization and were eligible for HCA’s charity care program in hospitals across the nation. The average bill for those people was $20,119. A total 33 completed applications for care and 18% had debt forgiven.
Tell us your charity care story:
Have you received charity care for bills with a Mission Health hospital or anywhere else in Western North Carolina? We'd like to hear your story. Call, text or email reporter Andrew Jones at 828-226-6203 or arjones@citizentimes.com.
Andrew Jones is an investigative reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at @arjonesreports on Facebook and Twitter, 828-226-6203 or arjones@citizentimes.com. Please help support this type of journalism with a subscription to the Citizen Times.
This article originally appeared on Asheville Citizen Times: Patient advocates to HCA Mission: Make your charity application public
