Despite the progress Massachusetts and the nation have made increasing the number of those with health insurance coverage, many people face staggering medical bills. A 2014 study by the Blue Cross Blue Shield of Massachusetts Foundation found that health care costs were a problem for 42.5% of Massachusetts adults. Health care costs aren’t just a widespread financial burden; they are a major obstacle to health care. Nearly 60% of Massachusetts families with financial problems caused by health care spending cut back on health care as a result according to the same 2014 study.
As the leading provider of pro bono legal services for Massachusetts residents with medical debt, vulnerable consumers throughout the Commonwealth seek our help addressing medical bills they shouldn’t have received and/or simply can’t pay. HLA lawyers protect low-income consumers from illegal medical billing and collection practices and, in many instances, secure reimbursement for health care providers. We preserve our clients’ ability to pay for basic needs like food, housing and clothing and access health care.
In 2013, HLA represented 293 low-income clients with unaffordable medical debt and eliminated more than $710,000 of their medical bills through legal advocacy. Many of our 2013 clients were denied their right to apply for coverage. Numerous others we represented received care after being told incorrectly their services would be covered.
A job loss, a heart attack and $100,000 in medical bills
HLA recently concluded our representation of “Cynthia”, a 64-year-old Chicopee woman who came to HLA with $110,000 in medical bills for emergency triple bypass surgery following a heart attack. Our client had lost her health insurance when she was laid off. She was nearly eligible for Medicare so, even though she hadn’t been feeling well, she held off on seeing a doctor. She had the heart attack and lifesaving surgery the day before her Medicare coverage began.
An HLA attorney helped Cynthia, who has only $1,400 in monthly income, enroll in state-subsidized coverage to supplement her Medicare, but the program would not retroactively cover her surgery bills. However, based on her eligibility for the state program, HLA negotiated forgiveness of $99,277 of her medical bills. With HLA’s help, her last bill was reduced to less than $3,000 which Cynthia is paying off over time. After her recovery, Cynthia wrote to HLA, “I didn't know where to go. I didn't know where to start or who to ask. I don't know what I would have done if I didn't have HLA to turn to. HLA really saved me.”
Policy Reforms to Prevent Medical Debt
Through our representation of clients with medical debt, HLA has identified problems in our health care system that repeatedly cause consumers to receive unwarranted medical bills. We advocate for public policy reforms to prevent consumers from accruing unnecessary medical debt by fixing these problems.
In May, 2013, HLA organized compelling testimony by an HLA attorney, former HLA clients and other advocacy groups for a Massachusetts State House public hearing in support of the Act Preventing Unnecessary Medical Debt a bill that HLA developed with State Representative Jeffrey Sanchez, the co-chair of the Legislature’s Public Health Committee. The measure protects low-income consumers from medical debt by promoting hospital financial assistance policies and limiting charges and unfair collection practices. It also helps hospitals receive reimbursement by helping patients enroll in safety net programs. HLA attorneys also pressed for state and federal regulations that will prevent medical debt in 2013. We advocated for new state rules to ensure low-income consumers can enroll in the state’s Health Safety Net program and to help providers determine patients’ health plan eligibility at the point of service. HLA also remained supportive of provisions in pending federal rules to require non-profit hospitals to implement certain reasonable policies to protect patients from financial distress as a condition of maintaining their tax-exempt status.