Karen King calls it “the ultimate paradox”: the hospital that saved her husband Jeff’s heart also broke it.
What happened Jeff King of Lawrence, Kansas, needed a procedure called an ablation to get his heart’s rhythm back to normal. Jeff asked the hospital for a cost estimate, but he said he had not been contacted before his scheduled surgery at Stormont Vail Health in Topeka, Kansas, in January 2021.
The real pain came when the bill arrived in the mail a few weeks later. The Kings, who had no insurance at the time, covered nearly all costs.
Jeff King63, Lawrence, Kang.
Approximate Medical Debt: $160,000
Medical Issues: heart resection
Jeff and Karen King received a $160,000 bill weeks after Jeff underwent a procedure to restore his heart rhythm. The Kings were initially into almost all of it.
Instead of subscribing to traditional health insurance, Kings participated in a so-called “medical cost sharing plan” for a company called Sedera. Sedera describes its service as “a fresh, non-insurance approach to managing high and unexpected health care costs.”with this instead of health insurance, the members agree to share the costs with each other.Plans are often faith-based and have grown in popularity in recent years Because it can be cheaper than traditional insurance. direct primary care medical practice.
But the shared plan Offer less protection More than insurance, it comes with a proviso. Kings said their plan did not fully cover pre-existing conditions such as Jeff’s heart condition during his initial two-year period of coverage, which necessitated surgery 16 months later.
“The way our system works is so tragic.
A Sedera spokesperson said in a statement that it is important for members to understand the cost-sharing model and membership guidelines. “Members of Cedera have read and agree to these before participating,” the statement read.
The Kings dabbled in health insurance of all kinds during their 42-year marriage. It was very rare. An exception occurred during a recent mission in which Jeff led the congregation since his 2015. Kareen recalled feeling “not worth it” for the $1,800 a month the congregation paid for insurance.
“We certainly hadn’t come up with that kind of premium on our own,” she recalled.
But Jeff decided he had to quit that job in 2018. Marriage (“Maybe God is far more inclusive than we are”).
After Jeff resigned, Kings briefly purchased insurance through the Affordable Care Act Marketplace, but later withdrew it because he felt he was ineligible for the subsidy and could not afford it.
At that time, they joined the Cedera Project. They knew the pre-existing condition clause was a gamble, but they didn’t realize that medication had controlled Jeff’s heart condition for years and would require medical attention to address it. .
What’s broken: Without employer-sponsored insurance and federal subsidies to cover premiums, the Kings felt that traditional insurance wasn’t worth the price. But because they don’t have insurance, they’re exposed to hospital bills that regular patients don’t see.
Health economists generally understand hospital costs as follows: a little like actually the price normally paidInstead, they are the first salvo in high-stakes negotiations between hospitals trying to get as much money as possible to provide care and insurance companies trying to get as little as possible.
But patients lack the bargaining power of big insurance companies. Insurance companies may cover hundreds of thousands of patients in any hospital’s jurisdiction. For patients like Jeff, the primary resource is access to hospital financial assistance programs, but even with that assistance, many patients cannot afford the bills the hospital sends them.
Stormont Vail’s assistance program ultimately deducted approximately $107,000 from Jeff’s original bill several months later. Cedera provided a negotiator to help him negotiate the cost.
According to tax returns, Stormont Vail provided $19.5 million in financial assistance and wrote off approximately $13 million of bad debt in the 2020 tax year. Net revenue from patient services he had $838.7 million.
Stormont Vail administrator Bill Lane said the hospital not only provides financial assistance, but also works with patients facing high bills and offers interest-free payment plans. rice field. Payments are often within his 10% of a person’s monthly income,” Lane said. For some patients, the hospital has a “catastrophic discount” program that caps the balance at 30% of total household income. Local banks may provide loans to patients to pay their bills, and hospitals may send patient balances to debt collection agencies.
Lane said he usually recommends that patients take out traditional insurance. He also said the hospital offers a “patient estimate module,” suggesting that if patients need an estimate “to make an informed decision,” they should wait to schedule surgery if possible. said that he is
What remains: Despite Cedera’s two-year waiting period to cover the existing condition, the plan gave Jeff $15,000 to help with the bills. After that, in November 2021 his final balance was reduced to $37,859.34.
Regarding his payment plan, Jeff said he was told the hospital would accept more than $500 a month. Jeff estimates it will take him over six years for his family to pay off.
“We didn’t expect this to cost us anything,” Jeff said.
The Kings are piecing together the funds to pay what they owe the hospital. A few months after Jeff’s mutilation, they raised his five children, sold his City home in Osage where Jeff grew up, and bought Lawrence a smaller house. Jeff’s decades of pastoral activity did not include a pension or a 401(k), so they hoped to use the money to build a retirement account.
In return, the sale of the house is helping pay for Jeff’s medical bills. Kareen had a part-time job and the two had life insurance.
Jeff started working as a hospice pastor — to earn an extra income, but especially so the couple could qualify for health insurance. This means he spends less time on his passion projects, A non-profit organization called Transmuto through which he provides spiritual guidance.
In February, Karen reconfirmed whether the couple could afford Affordable Care Act insurance so Jeff could return to Transmut full-time. When she searched her Google for the federal health insurance marketplace (HealthCare.gov), she unwittingly landed on her website, which sells consumer information to insurance brokers. She spoke on the phone with one of her brokers, who bought what she was told was Etna’s plan.But it turned out to be a cost sharing plan membership A company called Jericho Share,received 160+ Complaints In the past year, on the Better Business Bureau website
Jericho Share spokesperson Mark Hubbard said in a statement that the organization has “provided full refunds in the event of consumer disruption” and “has stepped up its marketing efforts to increase transparency and awareness.” We are continuing to evaluate and update.
Hubbard also said that Jericho Share is working with California regulators. new hampshire It questions whether the organization meets the state’s requirements of the Department of Health Care Sharing. I also question whether.
After canceling that plan and getting his money back, Kings eventually signed up for the ACA Marketplace plan, allowing Jeff to spend less time as a pastor and more time on Transmuto. Overall, the couple feels pretty lucky.
“Our system is so tragic,” Jeff said. “It puts so many people into impossible financial hardship.
KHN (Kaiser Health News) is a national, editorially independent program. KFFMore (Kaiser Family Foundation).
Copyright 2023 NPR. For more information, please visit https://www.npr.org.
