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Appendicitis + No Health Insurance = $43,000 Hospital Bill!

By: Aileen G., Bay County

In 2013, I was unemployed and ended up hospitalized for appendicitis. I had difficulty accessing my medical benefits through the Department of Veterans' Affairs (VA). I’m a Veteran and should have had full health benefits when I got discharged. I learned from my situation that the VA health benefits system is not a streamlined automatic system. When the doctor informed me that I needed to have my appendix removed, I first went to the VA website to find out what to do in an emergency situation. The website said that I needed to seek care and report it as soon as possible. My doctor told me to go to Bay Medical Center, our local community hospital, since I didn’t have health insurance coverage. I reported my surgery to the VA as soon as I was discharged.

During my admissions process at the hospital, they had a person come and talk to me about financial obligations, but Bay Medical Center never gave me any official financial aid/charity care forms or policies. Later I found out that on March 23, 2010, the Patient Protection and Affordable Care Act was signed into federal law. The law said that non-for-profit/501(c)(3) hospitals were federally required to have a financial aid policy that was publicly available to every person. It laid out the patients’ protections and affordable care rules. Hospitals were supposed to advertise the policies and give a copy to patients. The law even gave hospitals a financial aid policy format to use. Nonprofit hospitals had two years to comply with the law. So, when I was admitted in 2013, I should have received a copy of the hospital’s policy and someone should have talked to me about how I was going to pay for my surgery. However, this did not happen. The Florida Patient Bill of Rights statute also requires hospitals to provide this information to their patients.

After the surgery I was at home recovering when I was notified that the hospital had filed a lawsuit against me. The first judge I saw said that I had a legal defense when I said that the hospital needed to justify the cost of the surgery -- $43,000. We went to trial and the hospital withdrew the case. They filed another lawsuit and I was told I had to pay the outstanding bill. The new judge said that the hospital could charge as much as they like.

During the 2013 circuit court legal proceedings, I hired a patient advocate law firm and tried to get the case heard in federal court. I have repeatedly requested copies of the hospital’s financial aid policy and have never received it. Honestly, the hospital is out of compliance. I have spent hours on the phone speaking with the Florida Department of Revenue and the IRS's chief counsel's office. Bay Medical Center's tax status is questionable at best because of their court testimony. Still today, there are lots of questions about whether or not the hospital is actually a true nonprofit, which is a serious issue. A hospital cannot be 'a public charity' and 'a for profit hospital' at the same time.

My husband is from oversees and doesn’t quite understand the need to pay for health insurance. He has actually refused to pay for health insurance coverage for me. In the past I have applied for Medicaid for me and my son. My son was able to get it, but I was denied.

Today, I have health insurance through my employer. My health insurance issues with the VA have been somewhat resolved, although I still have issues with them paying my health bills. For instance, I have had two miscarriages in the last two years and went to the Gulf Coast Medical Center Emergency Room for treatment after receiving pre-authorization from the VA. My work health insurance covered part of it. The VA was supposed to cover the rest, but they did not. So, I’m forced to pay the balance out of pocket and have a very limited income.

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