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The over 6.2 million uninsured residents in California are naturally concerned about their health care, and their ability to get regular check-ups and ongoing medical treatment. But they also have good reason to worry about the financial repercussions of any medical problem that comes up. These anecdotes help to illustrate how uninsured families can have their financial futures ruined by the costs of care:
· Jesse James, a 42-year old uninsured independent contractor, fell off his roof last November, and was taken by ambulance to Loma Linda Hospital, where he was treated for severe brain damage and received a crainiotomy. Due to injury and trauma, he is wheelchair-bound and has various medical problems, requiring 24-hour supervision, ongoing therapy, and medication. His wife, Susan James, was working at a law office but quit to take care of her husband. She put several of the initial bills on her credit card, which now has debt of $14,000. Over and above that, Loma Linda Hospital is billing the couple for $278,000. After much negotiation, the couple has finally been able to obtain and submit applications for the hospital's charity care program and Medi-Cal, both of which are pending. Jesse currently gets continuing care at Los Angeles County-University of Southern California Hospital, but is unable to see recommended specialists at Loma Linda given the reluctance of the providers to provide care to someone with unclear Medi-Cal status. The couple has moved into his mother's home and is renting out their own house to make payments on the mortgage. Susan James continues to struggle with the mounting bills and debt.
· Soklinda Em, 21 years old, is a Los Angeles area student at Cerritos College with little income. She lost her health care coverage after leaving her job at Disneyland to start school. After several days of fatigue, she became dizzy and fainted and was taken by ambulance to Coast Plaza Doctors Hospital. She was diagnosed with a kidney infection and was treated with antibiotics. She was discharged after six hours, but was never informed of any coverage or payment options. She soon received bills for her emergency room visit totaling over $4,000. When Neighborhood Legal Services called for a charity care application, the hospital said they didn't have any such program, and proposed instead a payment plan. As she is a student, she has no current income to meet such a plan, and the hospital is threatening to send the bills to a collection agency.
· Martin Cervantes, 67 years old, underwent triple bypass surgery at Sharp Chula Vista Hospital and a balloon angioplasty from Paradise Valley Hospital in May 2000. The hospital bills amounted to approximately $100,000, far greater than his insurance covered and much greater than his salary as a security officer. He was never told by the hospitals about the possibility of charity care or other financial options. After being referred to collection agencies, his attorney continues to negotiate with hospitals about whether he is eligible for charity care. It took eighteen months, after multiple requests, to even receive a charity care application from Paradise Valley, which was submitted and ultimately accepted. The attorney is still unable to get a copy of Sharp Chula Vista's charity care policy, since it was determined to be an "internal" document.
· David Smith, 57 years old, lives in Oakland and gets his income from maintaining a handful of rental properties, including a few in Sacramento. He is a healthy nonsmoker, yet he is uninsured, as health insurance would cost $850/month for him and his wife. While doing some renovations, he recently fell off the roof of his home, but without serious injury. He followed the advice of a responding ambulance driver, who strongly urged him to go to the emergency room to be checked for internal injuries. After a three-hour visit to UC Davis Medical Center, which basically amounted to a few tests and a CAT scan, he received a hospital bill for $15,000. He is currently contesting the bill with the hospital for overcharges.
· Greg Story is a 50 year old uninsured freelance writer. After several days of severe cramps and constipation, he was rushed by ambulance to Valley Presbyterian Hospital. He was informed his bowels had ruptured, and after a life-threatening colostomy, he was admitted to the intensive care unit for four days, and then transferred to the cardiac unit for another nine days. He was billed over $78,000, and was told to make an initial $1,000 payment, and sign a contract to pay $500 a month to cover the costs of his care. He was urged to apply for Medi-Cal, but not informed of any other options, including charity care. He is still unable to work since he has limited mobility, and the medical emergency has depleted his savings, even as he has made all his monthly payments to the hospital. While he has his Medi-Cal application pending, he worked with Legal Services to ask the hospital for a charity care application. The hospital said that they didn't have one. No renegotiated payment plan was offered and yet the hospital sent the bill to a collection agency. He now faces the likelihood of bankruptcy, and depression from his medical and financial woes.
· Kathy Van, 23 years old, is a college student who lives with her parents and sister in Sacramento. In May 2001, she was in an auto accident, and was taken to UC Davis Medical Center. Upon admission, she told the hospital that she had auto insurance, but not health insurance. She was treated for injuries at the trauma center, and was billed $10,547. She was not told about the possibility of applying for the county medical indigent program. When she applied months later for the program, it was too late for these county funds to cover her expenses, because the deadline had passed. The auto insurance is only covering $2,275 of the hospital bills, leaving her with an over $8,000 bill, which is more than the family's income for six months.
Uninsured families need information about their consumer rights and financial options, because sometimes they can qualify for the patchwork of programs that can help. This is often the best-case scenario: the patient gets the care he or she needs; the hospital gets reimbursed for its costs; the family avoids a financial nightmare.
· Timothy Gubbins, 35 years old, lives in Roseville, and was laid off from his job. Since COBRA was too expensive, he dropped off Blue Shield, but quickly found a new job in Sacramento, which provides a decent income and health insurance. During the first 90-days of his new job when he didn't have coverage, he experienced respiratory illness and was advised by a doctor to go immediately to the emergency room. At Sutter Health, he was hospitalized for a week, after an endoscopy and surgery. As a "self-pay" patient, he was billed for over $75,000. After the valiant efforts of legal services and caseworkers, he was enrolled in Medi-Cal, which retroactively covered the hospital stay.
· Carmen Espinoza was an AmeriCorps volunteer and student at American River College. She was in a car accident and was taken by helicopter to Roseville Hospital, where she was treated for major injuries, including broken ribs, a double break in her femur, and paralysis in the left side of her face. She received a bill for over $140,000. The hospital acted as her advocate to get her coverage, including helping her apply for Medi-Cal. For the couple of months she waited to get accepted for Medi-Cal, she was unable to get needed follow-up treatment, since she was still uninsured and unable to pay. Eventually, she needed to get rid of about $500 in savings for her education in order to qualify under the assets test in Medi-Cal. After she did that, Medi-Cal did pick up the cost of the treatment.
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