Friday, October 14, 2005

Lawsuit Alleges Catholic Healthcare West Over-Charged Uninsured Patients

The Los Angeles Times reported yet more allegations that hospitals charge higher "list prices" for patients least able to pay them, while giving discounts to insured patients. "Activist" K. B. Forbes, who heads Consejo de Latinos Unidos, in Los Angeles, launched a class-action suit against Catholic Healthcare West.
This is a not-for-profit health care system which claims to be "a system of 40 hospitals and medical centers in California, Arizona and Nevada. Founded in 1986, CHW is the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California." The system's mission statement is:
Catholic Healthcare West and our Sponsoring Congregations are committed to furthering the healing ministry of Jesus. We dedicate our resources to: delivering compassionate, high-quality, affordable health services; serving and advocating for our sisters and brothers who are poor and disenfranchised; and partnering with others in the community to improve the quality of life.
The lawsuit, however, charged that Catholic Healthcare West overcharged uninsured patients compared with what it charges those who have insurance. One plaintiff was Mirna Esupinian, who was billed $20,296 for a two-day hospital stay for gastritis. The lawsuit claimed that the "average private insurer" would have been billed $5,600, and Medicare, $3,994 for similar care. Estupinian took out a loan to pay her bill. The hospital suggested she raid her son's college savings to pay it.
Another plaintiff is Sergio Pantoja, who was billed $15,897 for a five-hour stay after he was in a hit-and-run accident. Again, the lawsuit claimed an average insurer would have been billed $4,451 for such a visit. Pantoja makes $9,000 yearly as a tattoo artist.
"Forbes said Catholic Healthcare West should have alerted these patients to charity care programs they may have qualified for and should have identified government assistance programs." "Forbes said the tactic preys on the fears of uninsured patients who want to protect their credit and have no idea what the regularly discounted rate is for a procedure."
We have previously posted about how not-for-profit hospitals frequently charge uninsured patients, who are often poor, much higher rates than insured patients. (See this link for a recent post about another suit by Consejo de Latinos Unidos, and an earlier post about the apparently ongoing congressional investigation of this billing practice.) This practice surely is yet another driver of high health care costs.
Worse, it directly undermines the hospital's charitable missions. In the example above, Catholic Healthcare West claims to offer "affordable health care," and to advocate for "our sisters and brothers who are poor and disenfranchised." How can the system's executives possibly square their stated mission with their bills to Ms. Esupinian and Mr. Pantoja?
Health care executives who actually try to fulfill their organizations' lofty mission statements would take us far down the road to the accessible, affordable, high-quality health care everyone says they want.


Anonymous said...

Please try to leave some space between paragraphs. Your posts are difficult to read.

Anonymous said...

As a patient seen at CHW's St. Mary's in Long Beach twice in 2004, I suspect that the hospital is seeking to "scam" patients WITH insurance as well.

It took me 8 months to resolve billing for two PRE-authorized CT's. They claimed my insurance denied them, but I found that they had never been billed. Yet I still had to argue for 8 months that point and the fact that they were pre-authorized.

The worst event was an emergency room visit. It was billed as an "unspecified DENTAL procedure" and of course, denied. I brought the mistake to the hospital's attention and have spent 1 1/2 years speaking with the director and the corporate headquarters on the issue.Recently I found out that a year ago they were told that under their contract with my insurance they COULD NOT bill me for this, but they still persist to call me weekly and send collection threats.

Both incidents seem to suggest that CHW may be intentionally avoiding payment by assignemnt through insurance with the hope of bullying unknowledgable patients into paying the FULL BILLED amount!This hospital serves a primarily low income and elderly community and I do not doubt that many people faced with a statement like " your claim was denied" never even bother to check and see why or what their rights are...they just find a way to pay, and then the hospital collects the full amount rather that the contracted amount that they would have had to accept from the insurance.

Anonymous said...

I too was an uninsured patient at Catholic Healthcare West who was charged $2,000 for an hour visit that resulted in 2 stitches. Heinous.

Anonymous said...

I'm not sure if this is the same St. Rose, although I think it is, especially if they have their billing and collections work outsourced to for-profit firms in the Midwest area, but these hospitals have some of the biggest idiots working on their accounts.

One place drags in these people right off the street, I mean as in one worked in a bar as a bartender, many of them absolutely illiterate (hospitals, read those notes that are being sent over for proof that the reps at those outsourced companies are, in some cases, illiterates who can't even spell or use proper grammar, and we don't just mean typos, either).

I mean, no wonder the billing and collections work is under fire! Hospitals! Maybe you need to rethink who you outsource to, huh?

Anonymous said...

I was a long term employee of Methodist Hospital, a Catholic Healthcare West facility, in South Sacrammento. Right now, there is a debate before the County Board of Supervisors who to give the trauma center II designation to in this area, Kaiser or Methodist. It is a heated battle. Methodist Hospital is playing dirty. They have given their employees a communication asking them to post negative comments about Kaiser in letters to the editor of three named newspapers. It is not the first time I have been made aware of shady dealing like this. For a religious organization, Catholic Healthcare West is more evil in action than good. I am very sure that Christ would not approve. I am sure that the uninsured people were overcharged on purpose. Catholic Healthcare West is not doing good financially and they need revenue to expand. I don't know where they are getting the money to try and make Methodist Hospital a trauma center.
As a former employee, I am sure that I worked without help (and didn't get paid for my missed rest periods and meal breaks) due to the hospital trying to save money(at my expense.) I am so glad that Catholic Healthcare West has to pay back the patients that they
robbed, overcharged. I hope that it teaches them a lesson. Methodist Hospital should have to pay back the employees that they treated with discrimination. Methodist Hospital should make right all that they have done wrong and the people they have wronged. This is a big list my friends. A big, long list.

Anonymous said...

Isn't it something that the people here were hispanic in name? Half the people seen are non-insured, illegal mexicans and the get the care for free. I, in the meantime have to pay my bills. They have cell phones, salon done hair and nails, gold jewelry and gems dripping off of them and need a translator to even be spoken to. Gastritis is a common theme for these people who then have 40-50 "relatives" visiting who raid the nourishment rooms and steal what they want. I'm tired of the bleeding hearts out there who fall for it. Exactly why do you think our costs are going up? Are you all that stupid that you can't recognize the fact that these freebies (mostly) or the cheaper rates are causing our hospitals to close or having to charge higher costs just to stay afloat. I work for one of these hospitals and I feel like I'm working in Mexico.