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Why One New York Health System Stopped Suing Its Patients

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Noam N. Levey
Wed, 15 May 2024 09:00:00 +0000

ROCHESTER, N.Y. — Jolynn Mungenast spends her days looking for ways to help people pay their hospital bills.

Working out of a warehouse-like building in a scruffy corner of this former industrial town, Mungenast gently walks through health insurance options, financial aid, and payment plans. Most want to pay, said Mungenast, a financial counselor at Rochester Regional Health. Very often, they simply can't.

“They're scared. They're nervous. They're upset,” said Mungenast, who on one recent call worked with an older patient to settle a $143 bill. “They do think ‘I don't want this to affect my credit rating. I don't want you to take my house.'”

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At Rochester Regional Health, that won't happen. The nonprofit system in upstate New York is one of only a few nationally that bar all aggressive collection activities. Patients who don't pay won't be taken to court. Their wages won't be garnished. They won't end up with liens on their homes or be denied care. And unpaid bills won't sink their credit scores.

American hospital officials often insist that lawsuits and other aggressive collections, though unsavory, are necessary to protect health systems' finances and deter freeloading.

But at Rochester Regional, ditching these collection tactics hasn't the bottom line, said Jennifer Eslinger, chief operating officer. The system has even been able to move staff out of its collections department as it spends less to go after patients who haven't paid.

Eslinger said there's been another benefit to the change: rebuilding trust with patients.

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“We think and talk a lot and strategize a lot about where is the distrust in health care,” she said. “We have to remove that as a barrier to meaningful health care. We have to get the trust with the populations that we serve so that they can get the care that they need.”

‘Folks Cannot Afford This'

Rochester Regional, a large health system serving a wide swath of communities along the south shore of Lake Ontario, is big, with more than $3 billion in annual revenue.

But in a place where once-mighty employers like Kodak and Xerox have withered, finances can be challenging. In 2022, Rochester Regional finished nearly $200 million in the red.

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Patients have their own challenges. Unable to afford their bills, many ended up in collections, or even on the receiving end of lawsuits. “We would go to court,” acknowledged Lisa Poworoznek, head of financial counseling at Rochester Regional.

Then, before the pandemic, hospital leaders looked more closely at why patients weren't paying.

The barriers became clear, Poworoznek said: confusing insurance plans, high deductibles, and inadequate savings. “There are so many different situations that patients have,” she said. “It's really just not as simple as demanding payment and then filing legal action.”

Nationally, nearly half of adults are unable to cover a $500 medical bill without going into debt, a 2022 KFF poll found. At the same time, the average annual deductible for a single worker with job-based coverage now tops $1,500.

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Instead of chasing people who didn't pay — a costly that often yields meager returns  — Rochester Regional resolved to find ways to get patients to settle bills before collections started.

The health system undertook new efforts to enroll people in health insurance. New York has among the most robust safety-net systems in the country.

Rochester Regional also bolstered its financial assistance program, making it easier for low-income patients to access free or discounted care.

At many hospitals, applying for aid is complicated — long applications that demand extensive information about patients' income and assets, cars, retirement accounts, and property, KFF Health has found. Patients applying for aid at Rochester Regional are asked to disclose only their income.

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Finally, the health system looked for ways to get more people on payment plans so they could pay off big bills over a year or two. Importantly, the payment plans are interest-free.

That was a change. Rochester Regional, like some other major health systems across the country such as Atrium Health, used to rely on financing companies that charged interest, which could add thousands of dollars to patients' debts.

“Folks cannot afford this,” Poworoznek said.

Ending ‘Extraordinary Collection Actions'

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Working more closely with patients on their bills Rochester Regional to stop taking them to court.

The health system also stopped reporting people to credit bureaus, a practice many medical providers use that can depress consumers' credit scores, making it harder to rent an apartment, get a car loan, or even get a job.

In 2020, Rochester Regional adopted a written policy barring all aggressive collections by the system or its contracted collection agencies.

That put Rochester Regional in select company. A 2022 KFF Health News investigation of billing practices at 528 hospitals around the country found just 19 that explicitly prohibit what are called extraordinary collection actions.

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Among them are leading academic medical centers, including UCLA and Stanford University, but also community hospitals such as El Camino Hospital in California's Bay Area and St. Anthony Community Hospital outside New York .

Also barring extraordinary collection actions: the University of Vermont Medical Center; Ochsner Health, a large New Orleans-based nonprofit; and UPMC, a mammoth system based in Pittsburgh. Like Rochester Regional, UPMC officials said they were able to scrap aggressive collections by developing better systems that allow patients to pay off their bills.

Elisabeth Benjamin, a vice president at the Community Service Society of New York, a nonprofit that has led efforts to restrict aggressive hospital collections, said there's no reason more hospitals shouldn't follow suit, particularly nonprofits that are expected to serve their communities in exchange for their tax-exempt status.

“The value is to promote health, to care about a population, to promote health equity,” Benjamin said. “Suing people for medical debt or engaging in extraordinary collection actions is really anathema to all those values,” she said. “Forget about your ‘cancer-mobile' or your child vaccination clinic.”

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Rochester Regional's approach doesn't eliminate medical debt, which burdens an estimated 100 million people in the U.S. And payment plans like those the system encourages can still mean big sacrifices for some families.

But Benjamin applauded Rochester Regional's ban on aggressive collections. “I give them big props,” she said. “It never should have been allowed.”

New laws in New York now prohibit all medical bills from being reported to credit bureaus and restrict other collection tactics, such as wage garnishments.

Many hospital finance officials nevertheless say they need the option to pursue patients who have the means to pay.

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“Maybe it's on a very specific case where there is an issue with someone just not paying their bill,” said Richard Gundling, a senior vice president at the Financial Management Association, a trade group.

But at Rochester Regional's finance offices, officials say they almost never find patients who just refuse to pay. More often, the problem is the bills are simply too big.

“People just don't have $5,000 to pay off that bill,” Poworoznek said.

On her calls with patients, Mungenast tries to reassure the patients on the other end of the line. “Put yourself in their shoes,” she said. “How would it be if that was you receiving that?”

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About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers' balances may be affected by major medical expenses. And the CED , a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

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KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

——————————
By: Noam N. Levey
Title: Why One New York Health System Stopped Suing Its Patients
Sourced From: kffhealthnews.org/news/article/diagnosis-debt-rochester-new-york-health-system-stopped-suing-patients-over-medical-bills/
Published Date: Wed, 15 May 2024 09:00:00 +0000

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4 Ways Vaccine Skeptics Mislead You on Measles and More

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Amy Maxmen and Céline Gounder
Wed, 22 May 2024 09:00:00 +0000

Measles is on the rise in the United States. So far this year, the number of cases is about 17 times what it was, on average, during the same period in each of the four years before, according to the Centers for Disease Control and Prevention. Half of the people infected — mainly — have been hospitalized.

It's going to get worse, largely because a growing number of parents are deciding not to get their children vaccinated against measles as well as diseases like polio and pertussis. Unvaccinated people, or those whose immunization status is unknown, account for 80% of the measles cases this year. Many parents have been influenced by a flood of misinformation spouted by politicians, , and influential figures on television and social . These personalities repeat decades-old notions that erode confidence in the established science backing routine childhood vaccines. KFF Health News examined the rhetoric and explains why it's misguided:

The No-Big-Deal Trope

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A common distortion is that vaccines aren't necessary because the diseases they prevent are not very dangerous, or too rare to be of concern. Cynics accuse public health officials and the media of fear-mongering about measles even as 19 states report cases.

For example, an article posted on the website of the National Vaccine Information Center — a regular source of vaccine misinformation — argued that a resurgence in concern about the disease “is ‘sky is falling' hype.” It went on to call measles, mumps, chicken pox, and influenza “politically incorrect to get.”

Measles kills roughly 2 of every 1,000 children infected, according to the CDC. If that seems like a bearable risk, it's worth pointing out that a far larger portion of children with measles will require hospitalization for pneumonia and other serious complications. For every 10 measles cases, one child with the disease develops an ear infection that can lead to permanent hearing loss. Another strange effect is that the measles virus can destroy a person's existing immunity, meaning they'll have a harder time recovering from influenza and other common ailments.

Measles vaccines have averted the deaths of about 94 million people, mainly children, over the past 50 years, according to an April analysis led by the World Health Organization. Together with immunizations against polio and other diseases, vaccines have saved an estimated 154 million lives globally.

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Some skeptics argue that vaccine-preventable diseases are no longer a threat because they've become relatively rare in the U.S. (True — due to vaccination.) This reasoning led Florida's surgeon general, Joseph Ladapo, to tell parents that they could send their unvaccinated children to school amid a measles outbreak in February. “You look at the headlines and you'd think the sky was falling,” Ladapo said on a News Nation newscast. “There's a lot of immunity.”

As this lax attitude persuades parents to decline vaccination, the protective group immunity will drop, and outbreaks will grow larger and faster. A rapid measles outbreak hit an undervaccinated population in Samoa in 2019, killing 83 people within four months. A chronic lack of measles vaccination in the Democratic Republic of the Congo led to more than 5,600 people dying from the disease in massive outbreaks last year.

The ‘You Never Know' Trope

Since the earliest days of vaccines, a contingent of the public has considered them bad because they're unnatural, as compared with nature's bounty of infections and plagues. “Bad” has been redefined over the decades. In the 1800s, vaccine skeptics claimed that smallpox vaccines caused people to sprout horns and behave like beasts. More recently, they blame vaccines for ailments ranging from attention-deficit/hyperactivity disorder to autism to immune system disruption. Studies don't back the assertions. However, skeptics argue that their claims remain valid because vaccines haven't been adequately tested.

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In fact, vaccines are among the most studied medical interventions. Over the past century, massive studies and clinical trials have tested vaccines during their development and after their widespread use. More than 12,000 people took part in clinical trials of the most recent vaccine approved to prevent measles, mumps, and rubella. Such large numbers allow researchers to detect rare risks, which are a major concern because vaccines are given to millions of healthy people.

To assess long-term risks, researchers sift through reams of data for signals of harm. For example, a Danish group analyzed a database of more than 657,000 children and found that those who had been vaccinated against measles as babies were no more likely to later be diagnosed with autism than those who were not vaccinated. In another study, researchers analyzed records from 805,000 children born from 1990 through 2001 and found no evidence to back a concern that multiple vaccinations might impair children's immune .

Nonetheless, people who push vaccine misinformation, like candidate Robert F. Kennedy Jr., dismiss massive, scientifically vetted studies. For example, Kennedy argues that clinical trials of new vaccines are unreliable because vaccinated kids aren't compared with a placebo group that gets saline solution or another substance with no effect. Instead, many modern trials compare updated vaccines with older ones. That's because it's unethical to endanger children by giving them a sham vaccine when the protective effect of immunization is known. In a 1950s clinical trial of polio vaccines, 16 children in the placebo group died of polio and 34 were paralyzed, said Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia and author of a book on the first polio vaccine.

The Too-Much-Too-Soon Trope

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Several bestselling vaccine books on Amazon promote the risky idea that parents should skip or delay their children's vaccines. “All vaccines on the CDC's schedule may not be right for all children at all times,” writes Paul in his bestselling book “The Vaccine-Friendly Plan.” He backs up this conviction by saying that children who have followed “my protocol are among the healthiest in the world.”

Since the book was published, Thomas' medical license was temporarily suspended in Oregon and Washington. The Oregon Medical Board documented how Thomas persuaded parents to skip vaccines recommended by the CDC, and reported that he “reduced to tears” a mother who disagreed.  Several children in his care came down with pertussis and rotavirus, diseases easily prevented by vaccines, wrote the board. Thomas recommended fish oil supplements and homeopathy to an unvaccinated child with a deep scalp laceration, rather than an emergency tetanus vaccine. The boy developed severe tetanus, landing in the hospital for nearly two months, where he required intubation, a tracheotomy, and a feeding tube to survive.

The vaccination schedule recommended by the CDC has been tailored to protect children at their most vulnerable points in and minimize side effects. The combination measles, mumps, and rubella vaccine isn't given for the first year of a baby's life because antibodies temporarily passed on from their mother can interfere with the immune response. And because some babies don't generate a strong response to that first dose, the CDC recommends a second one around the time a child enters kindergarten because measles and other viruses spread rapidly in group settings.

Delaying MMR doses much longer may be unwise because data suggests that children vaccinated at 10 or older have a higher chance of adverse reactions, such as a seizure or .

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Around a dozen other vaccines have discrete timelines, with overlapping windows for the best response. Studies have shown that MMR vaccines may be given safely and effectively in combination with other vaccines.

'They Don't Want You to Know' Trope

Kennedy compares the Florida surgeon general to Galileo in the introduction to Ladapo's new book on transcending fear in public health. Just as the Roman Catholic inquisition punished the renowned astronomer for promoting theories about the universe, Kennedy suggests that scientific institutions oppress dissenting voices on vaccines for nefarious reasons.

“The persecution of scientists and who dare to challenge contemporary orthodoxies is not a new phenomenon,” Kennedy writes. His running mate, lawyer Nicole Shanahan, has campaigned on the idea that conversations about vaccine harms are censored and the CDC and other federal agencies hide data due to corporate influence.

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Claims like “they don't want you to know” aren't new among the anti-vaccine set, even though the movement has long had an outsize voice. The most listened-to podcast in the U.S., “The Joe Rogan Experience,” regularly features guests who cast doubt on scientific consensus. Last year on the show, Kennedy repeated the debunked claim that vaccines cause autism.

Far from ignoring that concern, epidemiologists have taken it seriously. They have conducted more than a dozen studies searching for a link between vaccines and autism, and repeatedly found none. “We have conclusively disproven the theory that vaccines are connected to autism,” said Gideon Meyerowitz-Katz, an epidemiologist at the of Wollongong in Australia. “So, the public health establishment tends to shut those conversations down quickly.”

Federal agencies are transparent about seizures, arm pain, and other reactions that vaccines can cause. And the government has a program to compensate individuals whose injuries are scientifically determined to result from them. Around 1 to 3.5 out of every million doses of the measles, mumps, and rubella vaccine can cause a life-threatening allergic reaction; a person's lifetime risk of death by lightning is estimated to be as much as four times as high.

“The most convincing thing I can say is that my daughter has all her vaccines and that every pediatrician and public health person I know has vaccinated their kids,” Meyerowitz-Katz said. “No one would do that if they thought there were serious risks.”

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——————————
By: Amy Maxmen and Céline Gounder
Title: 4 Ways Vaccine Skeptics Mislead You on Measles and More
Sourced From: kffhealthnews.org/news/article/measles-how-vaccine-skeptics-mislead-public/
Published Date: Wed, 22 May 2024 09:00:00 +0000

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California Pays Meth Users To Get Sober

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Angela Hart
Wed, 22 May 2024 09:00:00 +0000

GRASS VALLEY, Calif. — Here in the rugged foothills of California's Sierra Nevada, the streets aren't littered with needles and dealers aren't hustling on the corner.

But meth is almost as easy to by as a hazy IPA or locally grown weed.

Quinn Coburn knows the lifestyle well. He has used meth most of his adult life, and has done five stints in jail for dealing marijuana, methamphetamine, and heroin. Now 56, Coburn wants to get sober for good, and he says an experimental program through Medi-Cal, California's Medicaid program, which covers low-income people, is helping.

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As part of an innovative approach called “contingency management,” Coburn pees in a cup and gets paid for it — as long as the sample is clean of stimulants.

In the coming fiscal year, the state is expected to allocate $61 million to the experiment, which targets addiction to stimulants such as meth and cocaine. It is part of a broader Medi-Cal initiative called CalAIM, which provides social and behavioral services, including addiction treatment, to some of the state's sickest and most vulnerable .

Since April 2023, 19 counties have enrolled a total of about 2,700 patients, including Coburn, according to the state Department of Health Care Services.

“It's that little something that's holding me accountable,” said Coburn, a former construction worker who has tried repeatedly to kick his habit. He is also motivated to stay clean to fight criminal charges for possession of drugs and firearms, which he vociferously denies.

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Coburn received $10 for each clean urine test he provided the first of the program. Participants get a little more money in successive weeks: $11.50 per test in week two, $13 in week three, up to $26.50 per test.

They can earn as much as $599 a year. As of mid-May, Coburn had completed 20 weeks and made $521.50.

Participants receive at least six months of additional behavioral health treatment after the urine testing ends.

The state has poured significant money and effort into curbing opioid addiction and fentanyl trafficking, but the use of stimulants is also exploding in California. According to the state Department of Health Care Services, the rate of Californians dying from them doubled from 2019 to 2023.

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Although the cutting-edge treatment can work for opioids and other drugs, California has prioritized stimulants. To qualify, patients must have moderate to severe stimulant use disorder, which includes symptoms such as strong cravings for the drug and prioritizing it over personal health and well-being.

Substance use experts say incentive programs that reward participants, even in a small way, can have a powerful effect with meth users in particular, and a growing body of evidence indicates they can lead to long-term abstinence.

“The way stimulants work on the brain is different than how opiates or alcohol works on the brain,” said John Duff, lead program director at Common Goals, an outpatient drug and alcohol counseling center in Grass Valley, where Coburn receives treatment.

“The reward system in the brain is more activated with amphetamine users, so getting $10 or $20 at a time is more enticing than sitting in group therapy,” Duff said.

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Duff acknowledged he was skeptical of the multimillion-dollar price tag for an experimental program. “You're talking about a lot of money,” he said. “It was a hard sell.”

What convinced him? “People are showing up, consistently. To get off stimulants, it's proving to be very effective.”

California was the first state to this approach as a benefit in its Medicaid program, according to the Department of Health Care Services, though other states have since followed, including Montana.

Participants in Nevada County must show up twice a week to a urine sample, tapering to once a week for the second half of treatment. Every time the sample is of stimulants, they get paid via a retail gift card — even if the sample is positive for other kinds of drugs, including opioids.

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Though participants can collect the money after each clean test, many opt for a lump sum after completing the 24-week program, Duff said. They can choose gift cards from companies such as Walmart, Bath & Body Works, Petco, Subway, and Hotels.com.

Charlie Abernathybettis — Coburn's substance use disorder counselor, who helps run the program for Nevada County — said not everyone consistently produces a clean urine test, and he has devised a system to stop people from rigging their results.

For example, he uses blue toilet cleaner to prevent patients from watering down their urine, and has dismantled a spigot on the bathroom faucet to keep them from using warm water for the same purpose.

If participants fail, there are no consequences. They simply don't get paid that day, and can show up and try again.

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“We aren't going to change behavior by penalizing people for their addiction,” Abernathybettis said, noting the ultimate goal is to transition participants into long-term treatment. “Hopefully you feel comfortable here and I can convince you to sign up for outpatient treatment.”

Abernathybettis has employed a tough love approach to addiction therapy that has helped keep Coburn sober and accountable since he started in January. “It's different this time,” Coburn said as he lit a cigarette on a sunny afternoon in April. “I have support now. I know my life is on the line.”

Growing up in the Bay Area, Coburn never quite felt like he fit in. He was adopted at an early age and dropped out of high school. His erratic home life set him on a course of hard drug use and , including manufacturing and selling drugs, he said.

“When I first did crank, it made me feel like I was human for the first time. All my phobias about being antisocial left me,” Coburn said, using a street name for meth.

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Coburn escaped to the solitude of the mountains, trees, and rivers that define the rural landscape in Grass Valley, but the area was also rife with drugs.

Construction accidents in 2012 left him in excruciating pain — and unable to work.

Coburn fell deeper into the drug scene, as both a user and a manufacturer. “You wouldn't believe the market up here for it — more than you can even imagine,” he said. “It's not an excuse, but I had no way to make a living.”

Financially strapped, he rented a cheap, converted garage from another local drug dealer, he said. Law enforcement officers raided the house in October, and authorities found a gun and large amounts of fentanyl and heroin. Coburn, who faces up to 30 years in prison, vigorously defends himself, saying the drugs and weapons were not his. “All the other ones I did. Not this one,” he said.

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Coburn is also in an outpatient addiction program and is active in Alcoholics Anonymous, sometimes attending multiple meetings a day.

Every week, the small payments from the Medi-Cal experiment feel like small wins, he said.

He is planning to take his $599 as a lump sum and give it to his foster , with whom he is living as he fights his criminal charges.

“It's the least I can do for them letting me stay with them and get better,” Coburn said, choking back tears. “I'm not giving up.”

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This article is part of “Faces of Medi-Cal,” a California Healthline series exploring the impact of the state's safety-net health program on enrollees.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

——————————
By: Angela Hart
Title: California Pays Meth Users To Get Sober
Sourced From: kffhealthnews.org/news/article/california-pays-meth-users-sober-contingency-management-calaim/
Published Date: Wed, 22 May 2024 09:00:00 +0000

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He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.

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Bram Sable-Smith
Wed, 22 May 2024 09:00:00 +0000

Vincent Wasney and his fiancée, Sarah Eberlein, had never the ocean. They'd never even been on a plane. But when they bought their first home in Saginaw, Michigan, in 2018, their real estate agent gifted them tickets for a Royal Caribbean cruise.

After two years of delays due to the coronavirus pandemic, they set sail in December 2022.

The chose a cruise destined for the Bahamas in part because it included a trip to CocoCay, a private island accessible to Royal Caribbean passengers that a water park, balloon rides, and an excursion swimming with pigs.

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It was on that day on CocoCay when Wasney, 31, started feeling off, he said.

The next morning, as the couple made plans in their cabin for the last full day of the trip, Wasney made a pained noise. Eberlein saw him having a seizure in bed, with blood coming out of his mouth from biting his tongue. She opened their door to find and happened upon another guest, who roused his wife, an emergency room physician.

Wasney was able to climb into a wheelchair brought by the ship's medical crew to take him down to the medical facility, where he was given anticonvulsants and fluids and monitored before being released.

Wasney had had seizures in the past, starting about 10 years ago, but it had been a while since his last one. Imaging back then showed no tumors, and doctors concluded he was likely epileptic, he said. He took medicine initially, but after two years without another seizure, he said, his doctors took him off the medicine to avoid liver damage.

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Wasney had a second seizure on the ship a few hours later, back in his cabin. This time he stopped breathing, and Eberlein remembered his lips being so purple, they almost looked black. Again, she ran to find help but, in her haste, locked herself out. By the time the ship's medical team got into the cabin, Wasney was breathing again but had broken blood vessels along his chest and neck that he later said resembled tiger stripes.

Wasney was in the ship's medical center when he had a third seizure — a grand mal, which typically causes a loss of consciousness and violent muscle contractions. By then, the ship was close enough to port that Wasney could be evacuated by rescue boat. He was put on a stretcher to be lowered by ropes off the side of the ship, with Eberlein climbing down a rope ladder to join him.

But before they disembarked, the bill came.

The Patient: Vincent Wasney, 31, who was uninsured at the time.

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Medical Services: General and enhanced observation, a blood test, anticonvulsant medicine, and a fee for services performed outside the medical facility.

Service Provider: Independence of the Seas Medical Center, the on-ship medical facility on the cruise ship operated by Royal Caribbean International.

Total Bill: $2,500.22.

What Gives: As part of Royal Caribbean's guest terms, cruise passengers “agree to pay in full” all expenses incurred on board by the end of the cruise, including those related to medical care. In addition, Royal Caribbean does not accept-based” insurance plans.

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Wasney said he was surprised to learn that, along with other charges like wireless internet, Royal Caribbean required he pay his medical bills before exiting the ship — even though he was being evacuated urgently.

“Are we being held hostage at this point?” Eberlein remembered asking. “Because, obviously, if he's had three seizures in 10 hours, it's an issue.”

Wasney said he has little memory of being on the ship after his first seizure — seizures often victims groggy and disoriented for a few hours afterward.

But he certainly remembers being shown a bill, the bulk of which was the $2,500.22 in medical charges, while waiting for the rescue boat.

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Still groggy, Wasney recalled saying he couldn't afford that and a cruise employee responding: “How much can you pay?”

They drained their bank accounts, including money saved for their next house payment, and maxed out Wasney's credit card but were still about $1,000 short, he said.

Ultimately, they were allowed to leave the ship. He later learned his card was overdrafted to cover the shortfall, he said.

Royal Caribbean International did not respond to multiple inquiries from KFF Health News.

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Once on land, in Florida, Wasney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of dollars more in medical expenses.

He still isn't entirely sure what caused the seizures.

On the ship he was told it could have been extreme dehydration — and he said he does remember being extra thirsty on CocoCay. He also has mused whether escargot for the first time the night before could have played a role. Eberlein's mother is convinced the episode was connected to swimming with pigs, he said. And not to be discounted, Eberlein accidentally broke a pocket mirror three days before their trip.

Wasney, who works in a stone , was uninsured when they set sail. He said that one month before they embarked on their voyage, he finally felt he could afford the health plan offered through his employer and signed up, but the plan didn't start until January 2023, after their return.

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They also lacked travel insurance. As inexperienced travelers, Wasney said, they thought it was for lost luggage and canceled trips, not unexpected medical expenses. And because the cruise was a gift, they were never prompted to buy coverage, which often happens when tickets are purchased.

The Resolution: Wasney said the couple returned to Saginaw with essentially no money in their bank account, several thousand dollars of medical debt, and no idea how they would cover their mortgage payment. Because he was uninsured at the time of the cruise, Wasney did not try to collect reimbursement for the cruise bill from his new health plan when his coverage began weeks later.

The couple set up payment plans to cover the medical bills for Wasney's care after leaving the ship: one each with two doctors he saw at Broward Health, who billed separately from the hospital, and one with the ambulance company. He also made payments on a bill with Broward Health itself. Those plans do not charge interest.

But Broward Health said Wasney missed two payments to the hospital, and that bill was ultimately sent to collections.

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In a statement, Broward Health spokesperson Nina Levine said Wasney's bill was reduced by 73% because he was uninsured.

“We do everything in our power to provide the best care with the least financial impact, but also cannot stress enough the importance of taking advantage of private and Affordable Care Act health insurance plans, as well as travel insurance, to lower risks associated with unplanned medical issues,” she said.

The couple was able to make their house payment with $2,690 they raised through a GoFundMe campaign that Wasney set up. Wasney said a lot of that help came from family as well as friends he met playing disc golf, a sport he picked up during the pandemic.

“A bunch of people came through for us,” Wasney said, still moved to tears by the generosity. “But there's still the hospital bill.”

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The Takeaway: Billing practices differ by cruise line, but Joe Scott, chair of the cruise ship medicine section of the American College of Emergency Physicians, said medical charges are typically added to a cruise passenger's onboard account, which must be paid before leaving the ship. Individuals can then submit receipts to their insurers for possible reimbursement.

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He recommended that those planning to take a cruise purchase travel insurance that specifically covers their trips. “This will facilitate reimbursement if they do incur charges and potentially cover a costly medical evacuation if needed,” Scott said.

Royal Caribbean suggests that passengers who onboard care submit their paid bills to their health insurer for possible reimbursement. Many health plans do not cover medical services received on cruise ships, however. Medicare will sometimes cover medically necessary health care services on cruise ships, but not if the ship is more than six hours away from a U.S. port.

Travel insurance can be designed to address lots of out-of-town mishaps, like lost baggage or even transportation and lodging for a loved one to visit if a traveler is hospitalized.

Travel medical insurance, as well as plans that offer “emergency evacuation and repatriation,” are two types that can specifically assist with medical emergencies. Such plans can be purchased individually. Credit cards may offer travel medical insurance among their benefits, as well.

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But travel insurance plans come with limitations. For instance, they may not cover care associated with preexisting conditions or what the plans consider “risky” activities, such as rock climbing. Some plans also require that travelers file first with their primary health insurance before seeking reimbursement from travel insurance.

As with other insurance, be sure to read the fine print and understand how reimbursement works.

Wasney said that's what they plan to do before their next Royal Caribbean cruise. They'd like to go back to the Bahamas on basically the same trip, he said — there's a lot about CocoCay they didn't get to explore.

Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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By: Bram Sable-Smith
Title: He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.
Sourced From: kffhealthnews.org/news/article/surprise-bill-cruise-ship-seizures-travel-insurance/
Published Date: Wed, 22 May 2024 09:00:00 +0000

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