Cancer patient from Meredith ordered by judge to pay bill

LACONIA — A Meredith woman in a battle with breast and brain cancer is now facing the costly reality of not having medical insurance.

A Superior Court judge has ordered her and her husband, sued by Lakes Region General Hospital for non-payment of medical bills, to make payment secured by an attachment on their home.

In March, the hospital filed suit against Paul Hough and his wife, Wanda, of 19 Water St., Meredith for $48,081.26 in medical bills, plus accruing interest and legal fees connected to the collection efforts.

Judge Larry Smukler granted the hospital's motion for summary judgment on the basis of statements and evidence presented for the record without a trial. Such action is used when there is no dispute to the facts of the case, and one party is entitled to judgment as a matter of law.

On Tuesday, the court also ordered the Houghs to pay $1,742 in attorney fees. Earlier this month, the court granted the hospital a $55,000 attachment against the Hough's modest Cape-style home in Meredith.

Mrs. Hough, 55, received treatment for breast cancer at the hospital between Aug. 2, 2004 and June 28, 2004 and underwent a single mastectomy. She has since been diagnosed with brain cancer.

She claims that just five days after having a brain tumor removed at Dartmouth-Hitchcock Medical Center she was getting phone calls from the hospital asking for money for her prior surgery.

"I'm sure there are a lot of other people in the community thinking 'this could be me,'" said Maureen Criasia, a friend of the Houghs who worked as a registered nurse for 30 years.

As health insurance costs continue to increase, Criasia predicts more people will be unable to afford health insurance and will be saddled with huge medical bills if they get sick.

"We owe the money and we know we owe the money," said Paul Hough, maintaining the collection tactics employed by the hospital have placed additional stress on his wife while she is battling a life-threatening illness.

The couple didn't have insurance when the diagnosis was made. They'd dropped their coverage and used the added cash to help bolster the operation of their antique and used furniture shop.

In its lawsuit, the hospital, through its attorney, Margaret Sullivan of Laconia, charges that the Houghs failed to pay the costs of the medical care even though Mrs. Hough had signed a standard agreement on admission authorizing the hospital to begin collection proceedings if the bills weren't paid.

The writ claims the Houghs were "unjustly enriched" by the services the hospital provided.

On March 1, 2005, Lisa Delaney a patient accounts supervisor at the hospital signed a petition to attach with notice asking the court to order a $60,000 attachment against the Houghs real estate.

The petition claimed that the hospital believed it would recover a judgment in the amount of $60,000 and that unless the attachment was allowed there was a reasonable likelihood that the defendant's assets would be insufficient to satisfy a judgment.

Smukler granted the attachment but limited it to $55,000 and also ordered it "subordinate to all existing liens and attachments."

In a handwritten motion objecting to the attachment request, Hough said that the couple were in the process of applying for Medicaid and were currently making monthly debtor payments as part of a Chapter 13 bankruptcy plan accepted by the U.S. Bankruptcy Court in Manchester.

Court records indicate the Houghs paid $450 on the original $48,081.67 total hospital bill. The hospital is charging 4 percent interest daily and is also asking to recoup $145 in filing fees paid to the court, $44 paid to the sheriff's department for serving the writ of summons, $1,742 in legal fees, $1.34 in postage and $20.75 in photo copying fees.

Paul Hough says he tried to make weekly payments to the hospital but was told the nearly $50,000 bill would need to be paid in its entirety. The hospital offered to have them take out a mortgage on their home, but Hough rejected it as he thought the payments were unaffordable.

According to court records, the Houghs filed for bankruptcy on March 16, 2004. The bankruptcy court approved a repayment plan in which the couple began making monthly payments of $180 for 50 months in June 2004. Outside the repayment plan the Houghs are also paying their monthly mortgage plus making payments on their 1999 Ford van.

In a motion filed with the court on April 29, Mr. Hough said the couple had retained the services of an attorney with New Hampshire Legal Assistance, who had taken their Medicaid case and is confident that he can get the denial reversed and the medical bills due the hospital paid retroactive to 90 days to last April's filing date.

The couple has signed an agreement with state that explains state law mandates reimbursement from "my or my spouse's estate," to the state and county as a condition of eligibility for Medicaid. Under the terms of such an agreement, Hough said he and his wife could maintain lifetime residency of the home. The debt would be repaid upon their deaths when the property was sold.

Meanwhile, Hough says both Concord Hospital and Dartmouth-Hitchcock Medical Center have both provided medical treatment to his wife and have agreed to cover her expenses until they find out during a June 8 appeals hearing whether she will receive Medicaid.

Hough maintains LRGH fast-tracked collection efforts to avoid having to accept a Medicaid settlement that would pay less.

On May 3, the hospital filed a motion seeking summary judgment of post-bankruptcy petition debt claiming that the Houghs failed to amend their bankruptcy filing to add the hospital as an unsecured general creditor.

The Houghs objected. "The objection is based on a bankruptcy filing which occurred before the billed services were rendered. It is not based on the merits of the claim. As the record indicates the (hospital) is entitled to judgment as a matter of law on the undisputed facts. The motion is granted," Smukler wrote in his order granting the summary judgment.

Christopher Boothby, director of development and community affairs for LRGHeathcare (which owns LRGH and Franklin Regional Hospital) has characterized such suits as infrequent.

But a review of records in Belknap County Superior Court shows the hospital filed 165 such suits last year and has two attorneys working to collect on unpaid medical bills.

This year, 28 such cases had return dates in May, 20 in April and four in March.

While Boothby said he could not comment specifically on the Hough case, he said, the number of lawsuit filed by the hospital considering the number of patients it serves remains small.

"I would re-enforce that it's a situation of last resort. No one, not the patient, not the hospital wants to have a matter go to court. We work very hard to provide options to people," he said.

Boothby cited the Patient Advantage program that he said has attracted interest from other hospitals nationwide.

Boothby explained that the program was the brainchild of CEO Tom Clairmont, and was sparked after the administrator watched the "average guy charged more than the big HMO and realized there had to be a way to level the playing field."

If patients pay their bills at or near the time of service they can receive up to a 20 percent discount. More importantly, Boothby said, each time a patient is discharged hospital staff has the chance to meet with them, learn about their needs and has the opportunity to offer counseling or refer them to HealthLink or other programs that can help meet their needs.

But on the other side of the equation, Boothby maintains its unfair to individuals who meet their financial obligations to allow people who do have legitimate needs walk away without paying at least a portion of their bills.

"It's a delicate balance, one we've put a tremendous amount of time and energy into. To be fair to everyone in the community it sometimes become necessary to go to that last resort," Boothby concluded.

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As the Blue Cross administrator for our companies group plan, I can tell you that my wife and I's coverage would be $1800 per month.

I'm very glad you pointed this out. The only solution is to force poverty on these people to pay off the hospital. Then subsequent visits will have to be covered by medicaid if they are under 65 and medicare if they are older than 65. The problem with health care in situations like this is for the middle class. Wealthy people can pay, poor people don't have to pay. So why is it so expensive? What is needed? Did I hear something about limiting medical malpractice settlements? My last visits to a doctor were ridiculous as a doctor ordered every test possible to cover his insured butt. Gee no problem for me, my insurance covered it and passed it on in high rates. It works for me right now... later? I think I'd rather take the tumor and die in my own house.

The couple didn't have insurance when the diagnosis was made. They'd dropped their coverage and used the added cash to help bolster the operation of their antique and used furniture shop.

DING! They gambled and lost.

Medicaid?

Medicaid is so utterly abused. I witnessed firsthand a large group of Medicaid recipients at a hospital pharmacy not long ago. They were dressed to the nines, lots of gold jewerly, the latest in baggy pants and new sneakers. They all looked young and healthy. And all presented Medicaid cards to pay for their prescriptions. I was outraged!

Well based on being in the healthcare business myself (I am a doctor), there are alot of rules and regulations- many from the government (in the form of safety and privacy standards) but even more from the insurance companies. Each insurance company is allowed to set their own rules as to what is needed in order for the physician or healthcare provider to be reimbursed and if not followed precisely than the insurance company has the right to refuse payment. Sometimes they refuse anyway. We have one person in my small office who does nothing but deal with insurance and even with that collections hover between 80 and 85%. Insurance companies never want to pay because its not in their best interest to do so. Paying out does not please their stockholders or allow their executives to increase their salaries.

Malpractice insurance in my area of medicine is a relatively minor expense- but I am not a surgeon. I don't know of any physician that keeps a lawyer on retainer for malpractice reasons. Some hospitals do. Are physician group does keep a lawyer on retainer but not for malpractice but instead to deal with various hospital administrations. Defensive medicine in my area of practice is a non-issue, we don't practice it.

How much is the CEO of this hospital getting paid in executive compensation? A lot of money!

Probably not as much as he could make doing something else. If hospital executives and doctors don't get paid well, they'll take their capability and drive and go do something else.

Virtually all highly paid executives in all industries, use deferred compensation plans to minimize their tax bills (which remain enormous anyway -- and the hospital executives are already doing more than their fair share of paying other people's medical bills via their taxes).

" ...My last visits to a doctor were ridiculous as a doctor ordered every test possible to cover his insured butt... ."

It's up to us to call the doctor's offices and hospitals on these unnecessary tests and charges. if we are recouping from knee service and don't feel the in-home rehab care which is offered - or the potty chair - or the wheelchair - is necessary, we should decline them.

We should, in effect, be part of the quality control of the rising costs of healthcare.

When we take a hospital or doctor's bill and don't put it under scrutiny - because our health insurance is going to pay it anyway - we are ignoring a responsibility to keep the health insurance system and medical care system honest. ---- as honest as these two systems can be.

I haven't read all the posts prior to posting this but my spin on this is: If you use the service you pay the bill BUT when our government pays for every illegal, those who have nothing to take, or those who have found a way to divest their holdings from attachment it makes the picture different. When we live in a society where there are so many citizens and non-citizens who expect (and receive) these services it makes for the anger directed toward the hospital when you have people who have truly tried to be financially responsible and are put on the street so to say at a time of need. But then--don't most FR's advocate pay your own way--no government programs?

Yes, get government out of paying for health care, and also get government out of the business of prosecuting businesses for "discrimination". Let hospitals and doctors decide who they would like to treat for free. Right now, every time some gang-bangers bang each other up severely, the taxpayers get hit with hundreds of thousands of dollars in medical bills, just to patch the gang-bangers up so they can go out and do it again.

It's up to us to call the doctor's offices and hospitals on these unnecessary tests and charges.

Easy to say when one knows they are unnecessary. A little harder call to make when it comes to tumors, eh?

The amish we know don't have insurance. When they have an accident, one child got kicked in the head by a horse, he went to children's hospital and had a $150,000 + medical bill. They negotiated the bill and made payments on a much smaller portion. These people rolled the dice with their insurance and lost. I feel bad, but they need to work something out. I do think that it is BS that illegals don't have to go through this though.

I am not making less of the hospital CEO's qualifications or responsiblities.

Extremely high executive compensation for officers of corporations has been under scrutiny in this society for a while.

And for the particular hospital CEO that I know of personally to turn down more money yearly, it says he doesn't really need it to take care of his family and his upper middle class lifestyle.

It also says that he's astute with his financlal planning, I agree. Nonetheless, my point is, why be so petty with charging the patient's family when the CEO's family is so well taken care of?

Health care is too high in my opinion solely to justify the expensive nuclear or otherwise equipment in the facilities. Anyone who believes cures will be found for the devastating diseases is mistaken in my opinion. The pharmacetical and the medical fields would go broke.

"The couple didn't have insurance when the diagnosis was made. They'd dropped their coverage and used the added cash to help bolster the operation of their antique and used furniture shop."

So, to put it another way, the couple, finding the money spent on insurance might be better spent elsewhere dropped the insurance and took a gamble. They lost. Pay up.

Given the circumstances, it's another bad situation that fate often deals to people. No choice but to deal with it; but one thing I won't do (and I get this from my old man) is to ask the public to pay my bills.

If zoning laws allowed it, I would sell the house and install a bedroom, bath, and kitchen in the back of the antiques store. Give the balance to the hospital and move into the back of the store.

Otherwise, it's either bankruptcy or trailer park time.

What say you?

Let me give a reverse of this scenario.My wife had her tubes tied on December 17th,2003.The day after our second child was born.In April/May 2004,we found out we were now expecting child #3. After giving birth on December 28th,we scheduled for another tubal.(Different doctor,different hospital)

Upon examination,the doctor took photos of her tubes.One was not touched.The other was cut.Now,the hospital records show that both tubes were cut,and the individual pieces of tubes were varified by a lab tech at the hospital.We know this to not be true.

So,who's gonna pay for raising another child?I'd say the hospital and doctor owe me a hell of alot more than what this womans cancer therapy costs.I "guess" it's ok for the doctors and hospitals if they make a mistake,but screw the person who's dying?

IMHO,it all averages out.Those who can't pay are picked up by those who did pay,but didn't receive the proper care.If I had sued this doctor and hospital,I'd wager my settlement would equal quite a bit of unpaid hospital and doctor bills.

"At the very least, they should have paid enough for a catastrophic policy, to avoid bankruptcy in the event of a major illness or accident."

There are a couple of problems with this... Opting for a high deductible (even as much as $10,000) will only save you 10 or 15% in premiums.

Second, This MSA blabber some people are spewing is garbage if you own the business. Your not eligible for this if you own 10 or more percent of the business, and not at all unless you are insured in a qualifying insurance plan.

So you save little with a high deductible, and if you don't buy the insurance you cant get a MSA. Did you think these laws were written to benefit you?

I say that if I could find a doctor who doesn't deal with insurance, and who therefore charges what his services are truly WORTH (not what he thinks he can get from Medicare), I would patronize him in a second.

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