Hospital bills should not outlive our loved ones

In 2010, I lost my mother to cancer.  She was a fighter and had survived well past her prognosis, but her hospital costs outlived her.

Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the lower lobe of her right lung was indeed cancer, the surgeons performed a lobectomy.  We, of course, realized that this would come at a cost, but we had decent insurance coverage at the time. We certainly were not anticipating the cost to rival and even surpass the bills we paid after my sister was born, via Cesarean section, around that same time.

Following the recommendations of my mother’s oncologist and second and third opinion, my mother underwent six months of chemotherapy. The bills continued to accumulate. To complicate matters, the hospital’s billing system generated a new account number for each visit or procedure, making it difficult to track the bills and stay organized.

While we were considered to be in the middle class, had good insurance coverage and some savings, we could not keep up with the bills. My parents were constantly on the phone with the hospital, trying to figure out options. Could we have lower monthly payments? No. There is a required minimum payment. But we cannot afford that. What other options do you have? Let me transfer you to a different department.Could we be considered for any grant programs or hospital assistance? You are well above the income bracket for any federal or hospital assistance. Can we link the accounts? That is not possible under our current system. What can we do?

We resorted to paying what we could and racked up dozens of voicemails from bill collectors, not only from the hospital, but now our credit card companies. In the meantime, my mother was in remission for a little over two years. The number of required follow-up visits with her oncologist decreased, which helped reduce our financial burden. Unfortunately, it was short-lived. The cancer returned with a vengeance. The visits to her oncologist increased. She began radiation therapy; she also sought out alternative treatments. At this point, due to employment changes, we had a different insurance provider; they were a lot more accommodating of the situation than our previous insurer. It certainly was unexpected, given our previous conversations and experience with the previous insurance company.

As we look back, my family and I feel that the bills and dealing with our debt were a small price to pay to have my mother around for a few more years. But I know that, because of it, my mother did not only have a cancer burden but also a financial burden to worry about. We were fortunate in that while we struggled somewhat with the hospital bills, we were financially able to pay these costs, eventually. I know that there are many other families out there who are not as fortunate. We would ask that hospitals and insurance companies have more transparent information on costs and what the patient would be expected to pay. We would also advocate for flexible payment mechanisms, especially if eligibility for assistance is denied.

Furthermore, compassion and understanding should not be limited to the health care providers. The billing departments and other hospital administration sectors are also key members of the health team and often deal with patients and their families at vulnerable times. Their kindness and advocacy is just as important, if not more so, than the support provided to the patient prior to a major surgery or after hearing difficult news.

We hope that progress will see patients getting to focus on their health and precious family time, rather than worrying about health care bills.  The system should not allow hospital bills to burden or outlive our loved ones.

Nadi Nina Kaonga is a medical student.

Hospital bills should not outlive our loved ones

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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  • ninguem

    My father ran a car dealership and a garage. He bought the garage about 1968 to complement his dealership across the street.

    The building was erected about 1920.

    He inherited an employee, a mechanic, who was probably with the building from the day it was built. I think he fixed Model T’s. He kept him on, didn’t have the heart to let him go.

    He mentioned once, probably about 1970 or so, about making hospital payments for his daughter. I knew him well enough at that point, he didn’t have a daughter.

    Past tense.

    Seems she died of what sounds like leukemia, I was already becoming a premed nerd.

    He and his wife were making payments for medical care from the early 1960′s.

    Two things in retrospect.

    It’s a bummer to pay for the better part of a decade. His pride caused him to finish payment. At least some of the people involved had offered to waive the bill, he insisted.

    Another observation. Cancer treatment was something a man could pay off on a mechanic’s pay, without bankruptcy or poverty. He wasn’t rich, but did OK and lived a block away from our house.

    Hard to misbehave in that neighborhood in those days. A barrio in the good sense of neighborhood, there’s always eyes on you, and any kid’s mother had full permission to smack any other kid who misbehaved.

    Although I suppose, still another observation.

    I suppose today, that daughter’s cancer care, paid cash, would not be affordable on a mechanic’s pay.

    But she’d be alive.

    How to reconcile this?

    • Lisa

      One quick observation: you don’t really know how large the payments the mechanic was making versus the amount owed. Maybe he was paying off the debt, maybe he was just paying interest. Maybe the hospital wasn’t charging interest and he was whitttling away at the principal.

      I think hospitals are much more insistent on receiving payment for treatment than they were in the past. If you have to work out a payment plan, there is little flexibility.

      • ninguem

        No idea how much it was, I know……or at least he told me…….he paid it off. He, and his wife, became family friends over the years. I have no way of knowing what was arranged, payment, principal, interest, etc. My father offered health insurance to the employees, this history (the daughter with the leukemia) was before my father had bought the garage.

        And yes, I was born in the hospital in question, grew up a few blocks away, and practiced there for some time.

        They’ve gone corporate, and its a shame.

        • SarahJ89

          I don’t think hospitals charged interest in those days. And thank you for using the word complement correctly. (I’m an editor.)

  • Jenny Jackman

    Part of a larger discussion would be the cost of the treatment vs the benefit. In some cases, particularly in relation to cancer and chemotherapy, the treatment costs hundreds of thousands of dollars and has only been shown to increase life by 6 months. Of course, any doctor who tries to explain this to a patient or their family is advocating death panels and giving up on taking care of the patients, so doctors simply provide treatment and leave the families to cover the costs. Longer life doesn’t necessarily mean better quality of life.

  • Dr. Drake Ramoray
    • querywoman

      When my brother was in a nursing home for a couple of years before he passed away, I heard some old battle axe popping off at a family meeting that, “Medicare will get your house.”
      My mother and I never went back.
      It’s Medicaid, not Medicare, and there are exceptions.
      The laws are on the net and available for free.

  • querywoman

    Certified cease communication letters are the long-established and well-known way, as in federal laws, to deal with debt collectors.
    The way to deal with the multiple billing, the umpteen account numbers, is very simple. Ask for debt verification. Believe me, they will never be able to verify all the messes you describe.
    You do not have to ask for debt verification to send a cease communication letter through certified mail, though.
    Also, debts normally do not survive death, unless the decedent is was known to be wealthy.

    • SarahJ89

      Can you explain debt verification? I think I know what you mean (asking for an itemized bill?), but would like to know the details so I can advise people in this situation. Our local hospital is ruthless.

      • querywoman

        You send them a letter, preferably certified, and ask for verification for the bill. A computer printout from a collection agency that shows a simple lump sum is not acceptable!
        Get nickpicky! Request an itemized bill!
        I did this in the later 1980s, before I even knew much about debt collection. I saw on a bill that I was apparently charged for several syringes that were broken in an attempt to draw blood from my veins.
        I asked why I was being charged for their errors, and I never heard a word from them again.
        If your local hospital is “ruthless,” it’s probably breaking law after law.
        Bud Hibbs, a consumer advocate, used to have a great site, but he passed away. I’ll see if I can find another site.
        There are steps that are supposed to be followed before referral to debt collectors.
        Debts are legally charged off after six months. Most debt collectors don’t actually buy debts. A cease communication letter to a collection agency essentially refers the bill back to the original creditor.

  • Rob Burnside

    An elderly brother and sister from my street both became seriously ill at the same time and were admitted to different hospitals. They had a “bare bones” insurance policy and very little in savings. Both survived and were discharged to home with large bills soon arriving. His was forgiven, hers was not. She was taken to court and a lien was filed against their humble home. The difference? Her hospital was “corporate.” His was operated by the Sisters of Mercy, and is now closed. More accurately, it’s owned and operated by the corporation that filed the lien on their home. I’m not criticizing the corporate hospital. It’s a very good one, with strong community commitment. This is simply a study, in microcosm, of what has happened to healthcare over the past three decades. For better or worse, the quality of mercy is now corporate.

    • querywoman

      Did she try to fight the lien? Did she go to Legal Aid?
      There may even have been a state program to help her.
      Do they have heirs?
      Bankruptcy removes liens, but it may not be necessary if they don’t have heirs.

      • Rob Burnside

        She wasn’t a fighter, QW. Her brother died a year later, she stayed on another year, and wound up in assisted living for the final five years of her life–the best possible outcome, I think, under the circumstances. There weren’t any heirs. But I will say the lien caused a lot of stress they didn’t need on top of being old and ill.

        • querywoman

          True, the stress! It’s a scare tactic and mean-spirited.

          • Rob Burnside

            Yes, although the retort would be–”just business.”

          • querywoman

            I wonder if they hospital had fun selling the house???

          • Rob Burnside

            I don’t know, QW, but the buyer cut down all the trees and painted the place two-tone… a pale Chartreuse and something I’d call “flesh.”

  • Wayne Caswell

    Whenever someone brings up the issue of End-of-Life counseling, others start screaming about Death Panels. Could it be that the medical industrial complex just doesn’t want to lose paying customers but instead works to keep them coming back (and paying) by treating symptoms? That’s clled a Sick Care system, not health care.