From cancer center to courtroom

UVA Medical Center has sued more than 30,000 people over unpaid bills since 2010. One woman is pushing back.

Cancer. Major surgery. An uncertain prognosis.

It’s a nightmare situation no matter how you look at it. But when Zann Nelson got the phone call nobody wants to get in 2012—a UVA nurse practitioner telling her the tests she’d just gone through came back positive for uterine cancer—her vantage point was especially bleak. She didn’t have health insurance. 

The cost of the operation she got at her surgeon’s urging despite her fears about being unable to pay wasn’t necessarily catastrophic—it cost about as much as a new compact car—but it might ruin her financially anyway. Like tens of thousands of other locals in the last several years, she found herself on the receiving end of a civil suit brought by UVA over medical bills. Unlike most, she chose to fight the claim in court—by herself. 

“I’m not trying to push the responsibility off on anyone else,” Nelson said. “I never wanted to be pitied. I want to pay my bill.” She claims she was never told how much she’d owe, and that she felt taken advantage of when she was at her most vulnerable and was dismissed when she tried to work with the hospital. So she’s taking a stand.

It’s an unusual case, and one that brings up serious questions for the University’s medical center, which, like other public hospitals, is facing a future of major shortfalls as it struggles to fund its mandate to care for all patients, regardless of their ability to pay: Should care providers consider financial impact an essential part of the health care equation? And should a public hospital sue its way to a secure bottom line?

Zann Nelson. Photo: Brianna LaRocco

Bad timing

Zann Nelson describes her life as one of ups and downs, but mostly—thanks to thrift and hard work—ups. She brought up her two children on the Culpeper farm her father, a Pan-Am pilot who spent his boyhood on a Texas ranch, bought for his family in 1951. She raised cattle and trained horses, hung on to the land through a divorce, and found work as the director of a local nonprofit museum. Then came tragedy and hardship: Her son took his own life in 2003, just shy of his 18th birthday. Her second husband, who had been unemployed since 2001, left the following year, saddling her with heavy debts. Two years later, she lost her job.

Still, she managed. She worked with her bank to secure what she described as a “monster” loan that let her hang onto her house, writing, consulting on preservation issues, and bringing in a little income from rental properties in order to make payments. Despite the housing crash, the plan to sell off pieces of the farm to pay down debts was working, she said, albeit slowly. 

One thing that went by the wayside in the lean years, though, was health insurance. She’d paid out of pocket for a plan post-divorce, but the premiums kept climbing despite the fact that she made no claims, and she let it lapse. She was 63. She’d always been healthy. She figured she could stick it out until she was eligible for Medicare in a few more years. 

Then, just over two years ago, she was in the middle of lunch with a friend when she was seized with cramps. In the bathroom, she realized she was having what looked like a heavy period—which made no sense, as she hadn’t had one for at least a decade. Her first feelings were ones of panic.

“I wanted to cry, to have someone else fix the problem, care for me,” she said. But she knew none of those were options. And even before she left the restaurant, she was worrying about how much whatever problem had just reared its head was going to cost.

She didn’t think it could end up being everything she had left.

A surgery, a suit

Nelson tried her best to master her anxiety and come up with a plan. The receptionists at the busy office of the doctor who had once been her regular gynecologist told her to go to the emergency room if she was critical. She called her nearby free clinic instead, and was told to try the free clinic in Charlottesville. They told her she couldn’t be seen for a month, and to try UVA’s Midlife Health Center—which was not, as she remembers being told, a low-cost provider for the uninsured like the clinic.

When she arrived at UVA Imaging for an ultrasound, she said she was clear about her financial situation: She didn’t have insurance, and she was worried about being able to pay. The staff there had a ready solution, detailed in a bill that’s included in Nelson’s extensive records. They offered her a 20 percent discount on her $1,150 bill for the day’s procedures and a plan with monthly payments based around what she thought she could afford. 

That, she said, was the first and last straightforward conversation she had about money with her care providers.

Later the same day, at the registration desk at the Midlife Health Center where she went for a battery of tests, she asked again about cost. She was told she could file for financial assistance, but she doesn’t remember being given any other information, including a price tag for the procedures to come. It was busy. Someone handed her a small piece of paper the size of an index card to sign. She doesn’t remember that, but she knows she signed it.

She knows because it’s now labeled Exhibit B in her massive stack of court filings. Under the heading “Long Term Signature Agreement” is her name, along with the following in small type: “In consideration of services furnished or to be furnished, I guarantee payment to the Medical Center…and the Physicians Group of all outstanding balances incurred or to be incurred including those not paid by any third party source. If payment is not made when due, I agree to pay all reasonable costs and expenses related to collection of any outstanding balances, including but not limited to reasonable attorneys’ fees.”

Five days later, she got the phone call. She had Stage 1 uterine cancer. A few days after that, still reeling, she met with a surgeon at UVA’s Cancer Center, who recommended a complete hysterectomy within a month. Again, she said, she brought up her lack of insurance and her worries about the total cost.

Many months later in court, she tried to get the same surgeon to repeat the advice Nelson says she gave her in the exam room that day. The exchange, included in the trial transcript, was peppered with objections by attorney Peter Hetzel, representing UVA, and direction from Albemarle County Circuit Court Judge Cheryl Higgins.

“Did we have a conversation about my concerns of being able to pay the bills?” Nelson asked.

“I don’t recall,” the surgeon said, “but if we did—”

“Then I would object to anything further,” Hetzel interjected. “That’s the point I was making; she doesn’t recall this conversation that we are supposedly revisiting.”

Then Higgins: “The Court’s going to sustain the objection.”

“At any time, did you offer advice to me to not worry about the finances, that we needed to simply focus on my health?” Nelson went on.

“I—generally, that is what I would say, was that you can’t put a price tag on your life. This is my spiel to every patient, so I feel like I probably said it. And that I try not to think about…finances, because I so much want my decision-making to be only about my patient’s health and taking good care of them. And you know, we have a financial program that I will send patients to ask those questions because I don’t know.”

Nelson says nobody at the Cancer Center directed her to the financial counseling center. And the card with about 200 words of legalese that she’d blindly signed a few days before she got her diagnosis turned out to be the only contract for hospital care she’d ever see. 

So why didn’t she press the issue? Why didn’t she keep asking about the cost of what was coming until she got an answer?

“I know at any point I could have said, ‘Stop the horses, I want to get off,’” Nelson said. But she said she was afraid to do anything other than go ahead with rapid treatment. She figured that whatever the final bill, the hospital would work with her to hammer out a payment plan she could afford, she said, just as UVA Imaging had. The fact that her doctor was recommending surgery, and quickly, despite her financial concerns, seemed to support her assumption.

“I thought I was doing the responsible thing for my health,” she said.

She had the surgery in July. In e-mail exchanges with her surgeon afterward, she learned her cancer didn’t appear to be aggressive. Her incisions healed. She was hopeful. “With all sincerity,” she wrote to the surgeon, “you have reaffirmed my faith in the medical profession.”

The bills showed up in August. The UVA Physicians Group wanted $5,573, the Medical Center $27,802.51.

“I immediately started trying to work out some kind of plan,” she said. UVA offers an across-the-board 20 percent discount for patients without insurance, she learned. But because she owned assets well-over the state-regulated threshold of $3,200, she didn’t qualify for charity care. She was told her monthly payments would still total about $1,000 a month, she said—nearly her entire monthly income.

She eventually worked out a payment schedule with the Physicians Group, but the biggest bill, owed to the Medical Center, was still outstanding, and there was no plan in place to pay it down. For months, she said, she called and wrote, trying to get a meeting with someone. Eventually, she got a face-to-face with an administrator, but she said she couldn’t negotiate her payments down to something she could manage on her limited salary.

“There wasn’t anything concrete I could work with,” said Nelson. She heard nothing more until April, when the Rector and Visitors of the University of Virginia filed a civil complaint against her in Albemarle County Circuit Court for $23,849.21.

“I never thought it would be free,” she said. “I want to pay what was equitable. I’m still willing to pay.” But the monthly total was just too high. The money wasn’t there. She couldn’t afford a lawyer. She couldn’t find anyone to represent her pro bono. Her only choice, she felt, was to represent herself and fight the claim on the grounds that the contract wasn’t valid.

Charity care and collections

As a defendant on the receiving end of a UVA suit over medical bills, Nelson has plenty of company. According to numbers provided by Medical Center spokesman Eric Swensen, between 2010 and 2013, the hospital filed 30,392 cases against patient debtors in Albemarle County General District Court, which handles debt claims under $25,000. That’s about 4 percent of the total number of patients who came through the Medical Center in the same time period.

The number of civil cases rose more than twice as fast as the hospital’s annual patient population in those four years. A total of 6,967 cases were filed in 2010, and 8,297 in 2013—an increase of 19 percent. At the same time, the number of Medical Center patients went up just 8 percent in the same time period, from 197,643 to 213,353.

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Private hospitals like Martha Jefferson can turn away patients seeking care that’s deemed not medically necessary*, but publicly supported medical centers like UVA are required to treat everyone, regardless of ability to pay. That means it’s the public hospitals that typically bear the brunt of caring for more people who struggle to pay or can’t pay at all—and that’s a lot of people. A recent study by the Urban Institute’s Health Policy Center estimated that U.S. hospitals provided $84.9 billion in uncompensated care in 2013. UVA provided $234 million in financial assistance through uncompensated charity care last year, said Swensen.

In Virginia, public hospitals are teetering on the edge of a serious financial pit. The Affordable Care Act hinges on an expansion of Medicaid to offer more insurance to more people and a simultaneous scaling back of the amount of federal funds hospitals get as compensation for indigent care. But the ACA leaves the critical decision of whether to grow Medicaid up to the states, and after a protracted budget battle that threatened to shut down Virginia’s government, the Commonwealth said no to more Medicaid. Already, UVA and Virginia Commonwealth University saw $15 million in indigent care cut from the state budget this year.

Deb Thexton, Martha Jefferson’s director of finance, said private medical centers are facing new pressures, too. Uncollected debt became a much bigger issue for all hospitals when the recession hit, and shifts in the health insurance landscape aren’t helping. “If you look at the policies that are offered on the exchange”—the health insurance marketplace set up by the ACA—“more of them are moving toward higher deductible plans, which moves the burden of the payment to the patient, and the burden of collection to the hospital,” said Thexton. There’s no question, she said, that that’s going to increase the amount of bad debt care providers are left with.

There are similarities between UVA’s approach toward care for the uninsured and Martha Jefferson’s. According to Swensen and Thexton, both hospitals offer no-interest payment plans for big bills, financial assistance for those who meet income-based charity care thresholds, a discount for all uninsured patients (Martha Jefferson’s is 42 percent to UVA’s 20), and assistance in applying for Medicaid. UVA also devotes considerable resources to helping patients sign up for Family Access to Medical Insurance Security, or FAMIS, a program that provides insurance coverage plus some reimbursement for the hospital.

UVA’s Swensen said the hospital does ask patients at registration if they expect to have trouble paying their bill; if they say yes, they’re given an information packet with a financial aid application and Web addresses and phone numbers for more information. Doctors typically don’t weigh in when it comes to costs, he said.

“Our care providers are focused more on making decisions in the best interests of each patient’s care,” he said. “We have full-time financial counselors and a centralized pricing group available to assist patients in getting more information about costs.”

Thexton described a more proactive policy at Martha Jefferson: Besides handing a billing brochure explaining payment options to every patient at registration, hospital financial aid counselors approach every uninsured patient facing a bill expected to be over $25 individually to prompt a conversation about pay. It’s not unusual now for the hospital’s doctors to field inquiries from patients about costs, she said.

“I think that role that the physician plays is beginning to evolve as more and more folks become more responsible for a bigger portion of their care,” Thexton said.

And then there’s litigation. In the month of June this year, The Rector and Visitors of the University of Virginia filed 506 claims against debtors in Albemarle County District Court—more than 55 percent of the total civil claims sought by any plaintiff that month. Martha Jefferson filed none. Thexton said the number of claims filed by the hospital’s collections department fluctuations, but is often between 15 and 20 a month.

Swensen said UVA Medical Center does “everything possible” to work out a payment plan before filing a civil claim. “We view filing court cases as a last resort for collecting payment,” he said.

But local attorneys who handle medical debt cases said they’ve noticed that UVA takes a more aggressive stance towards debtors than it did 10 to 15 years ago. Yvonne Griffin is a personal injury lawyer who sometimes represents clients who are sued by the University for nonpayment of their hospital bills while waiting for insurance companies to cough up claim money after an accident.  

In such cases, “they used to withhold the bills if there was a lawyer involved,” she said, but these days, it’s more common to see UVA’s lawyers file a warrant in debt instead of waiting for the insurance payout. If a judge rules in their favor, they can start garnishing a former patient’s wages in lieu of payment.

Larry Miller of Miller Law Group pointed out that UVA doesn’t have to stop there. “They’re a state agency,” he said, “so if you file your tax return for the state of Virginia and you get a refund, they can seize that.”

Because UVA, like most hospitals, includes a provision in its care contract that covers fees for the attorneys they hire to collect, there’s less incentive for them to negotiate a settlement, said Miller.

“It’s an understandable place they’re coming from,” Griffin said. UVA has to take in patients private competitors might not, including cases where reimbursement in full isn’t a given. They can’t afford to hemorrhage money when people who can pay don’t.

“Certainly as a taxpayer, that would be important to me,” Griffin said.

She and Miller said one thing is certain if you decide to fight a bill: You have a difficult battle ahead.

“If you owe the money, and you admit to the court that you owe the money, then the judge has no choice but to enter the judgment,” said Griffin.

Miller agreed. “It’s not a winning battle,” he said. “Very rarely do you win those.”

Has he ever won in a debt dispute with UVA?

“I haven’t. Ever.”

Trial and tribulation

“I’m not a lawyer, and I don’t pretend to be a lawyer,” Nelson said. But over the course of the last year, she tried to fill the role on her own case. She asked for a jury trial, and the argument she laid out in court was this: The agreement she’d entered into when she signed the card handed to her on June 13, 2012 was so one-sided, thanks to unequal bargaining power and a lack of facts, that it constituted an unconscionable contract and was legally void. UVA was aware of about how much her procedure would cost and could have given her an estimate, Nelson said. The hospital had a stated policy of offering financial counseling. She was given neither, she said. Instead, she was handed a small card at a vulnerable time and told to sign.

“I don’t know how one could say that that constitutes a binding contract for unknown procedures, unknown costs in perpetuity, when it provides absolutely no resource for validating the contract,” she argued in court. “There’s no website, there’s no contact person; nothing. It’s just sign here and you’re bound to us forever.”

But the witnesses she tried to call—financial aid staff who could have testified that they didn’t counsel Nelson ahead of her surgery—were successfully quashed by Hetzel, the attorney representing UVA.

In the end, it came down to that little card she signed more than two years ago. Whether or not UVA had responsibly informed Nelson or determined how she would pay was outside the scope of the case, Judge Higgins said, and when it came to whether the card counted as a contract, she agreed with Hetzel. She granted summary judgement, and the jury never deliberated.

Case Number CL13-218, The Rector and Visitors of the University of Virginia versus Elizabeth Ann Nelson, was resolved, and Nelson was on the hook for another $8,377—accrued interest, plus Hetzel’s fee.

Nelson’s legal fight isn’t over. She’s filed notice of her plan to appeal Higgins’ ruling. She just won a small victory in a hearing this week, successfully stopping the illegal garnishment of her Social Security benefits.

Part of what’s driving her is a belief that the system needs to change. “It would have been so easy for the Medical Center to have provided information about costs, alternative health coverage and payment options,” she said. “For whatever reason, they did not.”

But she also knows that the cost of failure—to win an appeal, or to work out an agreement with the hospital, which she still thinks is possible—could mean bankruptcy and the loss of her father’s farm. She doesn’t see that as an option. Nelson said she’s determined to pay what she owes, she just needs time.

“I wasn’t taught to walk away from my obligations,” she said.

*Clarification: This story previously stated that the hospital can turn away patients with non-emergency conditions. It has been changed to reflect the fact that the hospital can only refuse care to those who are seeking treatment for conditions deemed not medically necessary.

  • themelungeon

    This is the state of healthcare in this country. Even with a recent survey that puts our healthcare system in last place out of a group of ten developed countries. We still see it as a commodity instead of a universal human right. This problem will continue to get worst until the profit motive is taken out of healthcare.

    http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/

  • Thomas Kelo

    It’s unfortunate, but government in the US is mostly to blame for the opaque health care system that we have (ignore any trolls who claim we have some kind of free market in healthcare, it’s a complete lie, attempting to cover the governments involvement in screwing up the US market for medical services). They don’t like to publish costs because it’s all a giant shell game that they play with medicare, medicaid, and private insurance companies. Hospitals are not legally allowed to charge less than medicaid for services, and since medicaid prices have been wildly inflated and negotiated between the AMA and the federal government, people like this get trapped and stuck with the same ridiculous prices the feds pay.

    This article is going to of course inspire some to say that this is the reason we need “universal health care” but the reality is that a large percentage of our country already does, and that is part of the problem. The federal government pays for over 50% of all healthcare costs, and that was before the ACA went into effect. Like everything the government pays for, costs have spiraled out of control (see also education, military spending) as they pumped more and more money in.

    Part of the reason costs have gotten out of control is a shortage of providers — we don’t have enough doctors because we don’t allow enough people to become doctors. We require a minimum of 10 years of training for general practitioners and 14-16 for surgeons!!! And there are limited slots for the residency programs because the federal government pays for, and limits how many slots are available.

    On top of that, Virginia has a system that limits competition among health care providers by requiring any hospital or office get a certificate of need before buying certain equipment (like MRI machines) or before opening a new practice group. So if Martha Jefferson wants to open a new clinic with a competing service to UVA, they have to first get permission from the bureaucrats in Richmond). Competition is the only thing that will drive down costs (as it does in EVERY OTHER INDUSTRY) and we are so stupid that we prevent that from happening.

    To see what healthcare COULD look like, see the Oklahoma Surgery Center who has been posting prices on their website for years. They don’t take insurance, they don’t take medicare, and they are far cheaper than what almost every other hospital in America charges for the same services. They get a lot of customers from countries like Canada where patients sometimes have to wait YEARS for elective procedures. https://www.youtube.com/watch?v=0uPdkhMVdMQ

    • Elliot

      We all want a healthcare system that is FAST, of the HIGHEST QUALITY, and INEXPENSIVE. Well folks, we can only have two out of these three at any time.

  • Really??

    All of us end up paying for those who do not have insurance (by choice or otherwise). Reform should help fix this.We moved here from a country with universal health care. I was shocked to see buckets/collections for people trying to pay for bone marrow transplants, etc. However, with the current system, if you “roll the dice” and choose not to cover yourself – then you risk HUGE expenses if you get sick. It’s a shame, but like any other bill – it should be paid.

  • Bruno Hob

    Bottom line: millions of Americans are going to need medical care they can’t afford (either no insurance or bad insurance). Choices: don’t treat them. Or if that seems inhumane, treat them and gov is going to pay for it. Choices then: current chaotic and indirect, administrative mess (with lawyers’ fees) Or direct tax funded universal care,like UK or Canada (and yes, I know about wait times in the UK and Canada). Is the latter expensive? Yes-but a lot less then ill considered imperial -adventures like Iraq War (2nd) and bad weapon systems. Your choice. If the pols let you choose.

  • Charles Morrill

    It seems too bad that the University Hospital could not have worked out some kind of realistic payment plan with this woman, who obviously wishes to pay. The hospital still relies on a certain measure of the community’s good will. I suspect many more situations like this will put a nice large dent in the Children’s Miracle Network fundraising and it need not have. If significant numbers of the community get sued by the hospital or know someone who has been, they will decide their charitable dollars need to go elsewhere and corporations will follow suit. I’ve heard of a lot of tough situations over the years, but what depresses me most about this one is that it’s pretty easy to solve. Set up a payment plan folks. This story is not about the need for universal health care, it’s about the universal need for some compassion and a little creativity. A top 100 hospital will not exist if it’s at war with the community it serves.

  • democracy

    Single. Payer. System.

  • democracy

    One of the commenters on this article opines that competition is the key to driving down health care costs. According to this commenter, competition has worked in “EVERY OTHER INDUSTRY.”

    Really? Seriously? Has this commenter – who goes by the name Thomas Kelso – studied American history? Has he never heard of J. P. Morgan, and U.S. Steel? Has he not heard of John Rockefeller and Standard Oil? What about the conglomerates that dominate agribusiness? Or the corporations that dominate cable and communications?

    Interestingly, those who often tout “free markets” don’t really believe in them. For example, as was recently reported in the Washington Post, “Starting in 1981, President Ronald Reagan appointed a number of prominent conservative economic thinkers to executive agencies and federal courts, and they moved swiftly to assert that the only goal of antitrust policy should be ‘economic efficiency.’ The traditional aims of antitrust — open markets, innovation, decentralization of power — were largely thrown out.”

    Clearly, as commenter Kelso pointed out, transparency in hospital medical pricing is a good thing. But transparency in pricing is something that professionals like doctors, lawyers, dentists, and pharmacists have long fought. Even now, prices in those areas can hardly be called “transparent.”

    And the Surgery Center cited by commenter Kelso is hardly a panacea for medical pricing. In fact, the “Surgery Center does work with insurance companies, but that triggers a separate pricing structure. Dr. Smith explained, ‘We take on a lot of risks when we file with insurance companies, so we have to charge for that risk’.” In essence, at the Surgery Center, if you can pay cash, you get a hefty discount. If you cannot, you don’t.

    Oh, and in real iife, Thomas Kelso was a Maryland businessman who “was also the president of the Baltimore Equitable Fire Insurance Company, one of the oldest such fire insurers in the nation.”

    in Baltimore, Maryland, as in other growing cities, “the need for fire insurance became increasingly evident.” That’s true today for homeowner’s insurance, car insurance, and health insurance.

    The ‘libertarian” view for better health care espoused by commenter Kelso really holds little if any water.

  • SinglePayerNow

    It’s amazing that even when you ask how much a procedure will cost, you get the run-around. The system makes it impossible for the consumer to know what they’re getting into. She signed that card under duress, that should totally not be a binding contract.

    • Bruno Hob

      Or, you are in an ER situation and you are in no position to eval. Or somewhere in between. Case: I was having slight rapid heart-rate/fatigue. Went to Doc on Fri afternoon. Doc says:you should have 4 routine blood tests done ASAP; our lab is closed. Go to local hospital for tests. NOT done on emergency basis. So that evening went to a local hospital for blood count, basic metabolic, heart protein and tick/lime labs. These are not esoteric lab-chemistries. Bill to me: $1000. I would never have submitted to tests had I known or thought to have asked the costs rather than having done at the docs on Monday. (final med verdict: nothing to worry about).Yeah, I was stupid. Patients are generally “stupid.”

  • LandlordWhisperer

    She had options for health insurance…when she lost her job, should could have continued coverage under the COBRA http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985 enacted under Ronald Reagan and paid for it herself. The unfortunate part is that she must divest herself of her family farm in order to qualify for “aid”….or declare bankruptcy

    • Bruno Hob

      Cobra is often more expensive than private insurance, Believe me, I was on it for a while. Faced with high monthly premiums,either by insurance or Cobra, with Medicare 2 year ahead, she made a bad gamble. Of course, she has assets that should, if necessary pay her bill. But why not an arrangement rather than break her?

      • LandlordWhisperer

        Her brother is a doctor AND she has assets AND she could have declared bankruptcy AND she could have kept up with her health insurance premiums….it is a matter of what is important to you…in the “business world” she SELF-INSURED which is a bad choice to make for something as important as health insurance.

  • Zann Nelson

    First, let me thank everyone for what reads as thoughtful commentary. I would like to respond to at least a few of the comments and maybe add a bit more of the story than there was space for in the article.
    To the individual who suggested that I could have enrolled in Cobra when I lost my job: I lost my job in 2006 and did not have health insurance with that employment. At the time I was insured under my husband’s policy and when he filed for divorce the cobra coverage was an option but the premiums dictated by his employer were considerably more than I could afford and provided coverage I did not need (i.e. pregnancy…I was beyond child bearing). I purchased coverage for myself through Anthem.
    and as the premiums continued to climb and my income to also decline, I let it lapse….granted that was my choice and I take full responsibility.
    As to the issues in this situation, it really boils down to communication and what is relevant information for a would be patient to be able to make an informed decision.
    I find the statements by Mr. Swenson perplexing. The article attributes to Swenson the following: “the hospital does ask patients at registration if they expect to have trouble paying their bill; if they say yes, they are given an information packet with financial aid application and Web addresses.” I registered at three different offices was never asked that question, was never offered screening for Financial assistance, but at the first stop was give one of two pages of the application for financial assistance. More interesting is the assertion that a packet is given. This was a most important element of my argument; there was no literature, FAQ sheet, direction to a Financial Counselor, or data related to costs or payment options available to me as a patient, even when I declared much like Henny Penny that “I had no insurance and was concerned about the cost.” During the trial the Medical Center’s chief witness, an administrator in Patient Financial Services, stated when asked if the hospital provided any kind of paperwork, brochure, “If we do, I am not aware of it.” Again in response to Production of Documents:
    Request for Any and all publications ( brochures, fliers, or other mechanisms of communication between University of Virginia Medical Center, its medical and business office employees including the office of Financial Assistance and patients or potential patients) offering the existence and availability for appointments, financial counseling (verbal or written), or information about and access to the Plaintiff’s website during a period from June 10 to August 2012 provided to patients, insured or uninsured, at The UNIVERSITY OF VIRGINIA MEDICAL CENTER regarding estimated costs, payment options and other possibilities for health care insurance:
    Answer: “Plaintiff is unaware of any such publications.”
    I did receive a service and it should carry a payment! What that payment should be is debatable.
    What is the formula used to decide how much the insurance companies pay for the same procedure vs what the uninsured pays?
    I learned, too late to apply that there exists a Federal Insurance program entitled PCIP for which I qualified and it would have paid all but $2,000 of costs. I have told dozens of people who were unaware of the program. Ironically, I was told of it in December by a social worker at the Cancer Center.

    Did the Medical Center offer me options after the fact? Yes, they did. In dribs and drabs I heard about a longer payment plan if I gave them a Deed of Trust (I knew that the bank that held all my assets as collateral would not give up a DoT (I did not know that a 2nd DoT was an option). I also was not told what the payment would be or for how long? I requested a sit down with a decision maker for a substantive work session. What I got after 4 months was a meeting where I was told there was nothing that the individual could do and then he offered to reduce the total to just under $18K but I must pay it in one lump sum. It was substantial indeed but far greater than what the insurance companies pay for paying in one lump sum, and I repeated that I simply did not have the funds. The conversation ended and has never been renewed.
    There are laws addressing what constitutes a “valid” or “unconscionable contract.” The Affordable Care Act mandates in section 9007 what written policies a non profit hospital must provide and make widely available to the community it serves.
    It seems to me that both parties in this specific situation and across the board share the responsibility for a mutually agreed upon contract and the resulting obligations.

    • Bruno Hob

      Well, Ms Nelson thank you for your candor. I realize,in fairness, there is a “UVa side” of this story too and, that as you seem to agree, you are finally responsible for your bill.This said, I harbor no illusions about the integrity of UVa. It is the 900 pound gorilla and anybody that works for UVa can tell you horrors of administrative- managerial abuse, malfeasance, arrogation, with victory by size and wealth over the little guy (or gal). (This is not to indite the many superb doctors, nurses and staff at UVa). Best of luck to you, and congrats at getting the cancer at Stage 1, the only cancer to get-if then.Stay well! This kind of bill mess happens all the time; most don’t have the means, energy or courage to fight. The only solution is a Canadian-UK type national health insurance plan. Really.

  • Zann Nelson

    check out http://www.zannsplace.com for updates on this saga

  • Zann Nelson

    For more stories on the maze and inequity embraced and proliferated by the healthcare industry go to a NY Times reporter’s Facebook page on healthcare issues…fascinating stuff!!
    https://www.facebook.com/groups/payingtillithurts/