Many hospitals in the United States use aggressive methods to collect medical debt. they Local courts flood with collective charges. they garnishment of patients’ wages. they Get hold of your tax refund.
But a wealthy nonprofit health system in the Midwest is among those taking things a step further: denying care to patients with unpaid medical bills.
Allina Health System, which operates more than 100 hospitals and clinics in Minnesota and Wisconsin and generates $4 billion in annual revenue, sometimes turns away patients with debt, according to internal documents and interviews with doctors, nurses and patients.
Although Allina Hospitals will treat anyone in the emergency room, other services may be cut off for patients with debt, including children and those with chronic conditions such as diabetes and depression. Patients are not allowed to return until they have paid their debts in full.
Non-profit hospitals like Allina receive large tax breaks in exchange for providing care to the poorest people in their communities. But New York Times investigation Last year, in the last several decades, there have been non-profit organizations They have fulfilled their charitable missionwith few results.
Alina has a clear policy of cutting off copays for services received by the health system’s 90 clinics. A 12-page document reviewed by The Times instructs Allina staff on how to cancel appointments for patients who owe at least $4,500 in unpaid bills. The policy goes over how employees can lock their electronic health records so they can’t schedule future appointments.
“These are very poor people with very serious medical problems,” said Matt Hoffman, a primary care physician for Allina in Vadnis Heights, Minn. “These are patients who need our care the most.
Alina Health said it has a robust financial assistance program that helps with medical bills for more than 12,000 of its 1.9 million patients in an average year. The hospital system only terminates patients if they accumulate at least $1,500 in unpaid debt on three separate occasions. Connie Bergerson, a hospital spokeswoman, said it contacts them by phone and frequent letters that include information about applying for financial aid.
“Alina Health’s goal is, and always will be, to have zero patients go without services,” Ms. Bergerson said. She said outages are “rare” but declined to say how often they happen.
Alina suspended its policy of cutting patients during the outbreak of the coronavirus in March 2020 before reinstating it in April 2021.
Supposedly 100 million Americans They have medical debt. Their bills account for nearly half of the country’s debt.
About 20 percent of hospitals nationwide have debt collection policies that allow them to cancel care. Examination KFF health news last year. Many of these are non-profit. The government does not track how often hospitals withhold care.
Under federal law, hospitals are required to treat all emergency room visitors regardless of their ability to pay. But the law — called the Emergency Medicine and Labor Act — is silent on how health systems treat other patients who need life-saving care, such as those with aggressive cancers or diabetes.
In the year In 2020, thanks to its nonprofit status, Allina saved an estimated $266 million in state, local and federal taxes, according to the Lown Institute, which studies health care.
In return, the Internal Revenue Service requires Alina and thousands of other nonprofit hospital systems to benefit their local communities, including providing free or reduced-cost care to low-income patients.
But federal laws don’t specify how poor a patient must be to qualify for free care. In the year In 2020, Alina spent less than 1 percent of its spending on charity care, compared to less than 2 percent for nonprofit hospitals nationally. Analysis By Gay Bay, a professor at the Johns Hopkins Bloomberg School of Public Health, hospital financial documents.
Allina is one of the largest health systems in Minnesota. As of 2013, annual profits ranged from $30 million to $380 million. Last year was the first time in a decade that it lost money due to investment losses.
Its financial success has paid dividends. The president of Alina received income 3.5 million dollars in 2021Most recent year for which data is available. The health system recently built a $12 million conference center.
However, Alina sometimes plays hardball with patients. Doctors are used to seeing messages in the electronic medical record stating that a patient is “no longer able to receive care” because of an “unpaid medical balance.”
Rita Raverty, a primary care physician at the Allina Clinic, said the notices are shocking because they mean she can no longer provide continuity of care for her patients, who have multiple health risks.
“Nobody wins when patients can’t get preventive care,” Dr. Raverty said. “When you don’t catch things early, it creates worse disease outcomes.”
Doctors and patients reported that children were unable to fill out medical forms required to enroll in day care or show proof of vaccinations to school.
Serena Gregert, who works as a scheduler at the Allina Clinic in Minneapolis until 2021, said the computer system simply won’t allow her to make future appointments for some well-balanced patients.
Ms. Gregert and other Allina staff said some of the discharged patients are eligible for low-income Medicaid, the federal-state insurance program for the poor. That means those patients will be eligible for free care with Alina’s own financial assistance. Policy – There is something that many patients do not know when they seek treatment.
Ms. Bergerson, an Allina spokeswoman, did not dispute that, but said the health system “makes every effort to help patients meet their financial obligations for medical care.”
Alina’s employees were forced to take care of the policy of rationing.
Beth Gunhus, a pediatric nurse, recalled a mother with her three children. One person had scabies, a very itchy skin rash caused by mites burrowing into the body. She wanted. Follow best practices And take care of the entire family sharing a bed in the same rented room to prevent further spread. But she can only write prescriptions for the two children. A third account was locked due to unpaid bills.
“There are so many better ways to save money than we do,” Ms Gunhus said.
Alina said the policy only covers liabilities related to care provided by her clinics, not the hospitals. But patients said in interviews that services they received at Alina hospitals were cut off after falling into debt.
Because Alina is the primary health system in some rural areas of Minnesota, the layoff could leave patients with few options.
Jennifer Bledo lives in Isanti, a small town outside of Minneapolis, where Alina owns the only hospital there. Ms. Bledow, a mechanic, racked up nearly $200,000 in bills after a two-week stay at Allina Mercy Hospital in 2009 for complications from pneumonia. Ms. Bledow, a mother of four, said most of her hospital stays were not covered by health insurance and she was unable to raise enough money to pay off the debt.
Last year, Ms. Bledow had a cancer scare and said she could not get an appointment with a doctor at Mercy Hospital. She had to drive over an hour to get checked out at a health system unrelated to Alina.
Alina does not make this policy clear to patients. is it Not mentioned In the list of “Frequently Asked Questions” about the health system’s billing practices. In at least one case, Alina even denied its existence.
In a lawsuit filed last year in Minnesota state court, Alina sued couple Jordan and Jolinda Anderson for nearly $10,000 in unpaid medical bills.
In court filings, the couple told how Alina canceled Ms. Anderson’s appointments and couldn’t make new ones until she set up three separate payment plans — one with the health system and two with debt collectors.
Even after setting up the $580/month payment plans, the canceled appointments could not be reinstated. Alina allows patients to return after paying the full amount.
Ms. Anderson remembers being devastated during a visit with an endocrinologist who specialized in her chronic health condition. She was already waiting four months for the appointment, and she could not get a new one.
“I felt like I was being punished, and the punishment was to stay sick,” she said.
Ms. Bergerson declined to comment on these matters, citing patient privacy.
When Anderson asked the court for a copy of Alina’s policy prohibiting unpaid bills, the hospital’s attorneys responded: “Alina does not have a written policy regarding cancellation of services or scheduled and/or physician referral services or appointments.” “Unpaid Debts.”
In fact, Alina’s policy, which was created in 2006, guides employees on how to behave. Among other things, it tells staff to “cancel any future appointments the patient has scheduled at any clinic.”
It provides a few ways for patients to continue to be seen despite unpaid bills. One is by getting approval for the loan through the hospital. Another is filing for bankruptcy.
Susan C. Beachy Research contributed.