Why Patient Advocates are Needed: A Hospital Bill Nightmare

In yesterday’s Boston Globe, there was a story by Kevin Cullen called “A Hospital Bill That’s Tough To Stomach.”   It is an unbelievable story of a family’s journey in the health system and ending up with a million dollar bill.  Here is the link to the story.

http://www.boston.com/yourtown/boston/roxbury/articles /2010/12/12/a_hospital_bill_thats_tough_to_stomach/

As an advocate, I have to say I was outraged by what happened to this family.  I deal with many billing issues but this one is the ultimate nightmare.  The father was hospitalized and then sent to rehab at Spaulding Hospital in Cambridge, MA.  He ended up being in the hospital for 2 1/2 years.  This in itself is unusual.  I don’t know any insurance especially medicare that would pay for the hospital or rehab that long.  The family felt they never had any information or input.  He was finally sent home and the family was given the one million dollar bill.  Because the family does not have a million dollars to pay, the hospital has put a lien on their house.  The father is 91 and the mother 87.

Why didn’t Spaulding move him to a nursing home?

How could a hospital allow this? I would like to see the paper trail where the family was advised of the bill and given options.  I would like to see the letters from the insurance companies notifying the family of no more benefits.  Where was the in house advocate and support team from the hospital?  And where was the case manager? Where was the voice of reason?  I know Spaulding Hospital and its systems and these teams are in place.

Spaulding has said they have offered a payment plan.  That is their defense?

One may ask, why didn’t the family become more involved and do they bear responsibility?  If a misplaced trust of the system and ignorance of the inner workings are  faults, then yes, they bear a part of the responsibility.

It is a story like this that magnifies the need for patient advocates.  The system does not put the consumer first nor consider the family as part of the team.  I know the difference an advocate can make in resolving issues, protecting patients from unnecessary medications and procedures ,and curtailing financial disasters. It takes guts to be the empowered patient and not everyone has the energy to fight.

My advise….Get an Elder Lawyer!