Posted on 05/19/2005 7:14:23 AM PDT by Jim Noble
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.
"This organization's commitment is secure and ongoing," he said.
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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I will look into catastrophic insurance through my employer, thanks to our chat.
My great advisor on insurance matters is my own father, the wise old man. I'm going to ask his opinion on catastrophic.
Sometimes, people don't "choose" to drop their coverage. As long as your insurance premiums are manageable and possible, good for you. We managed to pony up several thousand dollars a year in "health" insurance premiums for years, until because of automatic increases based on our age and supposed "deteriorating" health we finally just simply DID NOT HAVE THE MONEY TO PAY $10,000 A YEAR to the insurance company with premiums increasing by leaps and bounds yearly. It finally worked into a situation where we were making about half what we were 30 yrs. ago and simply could not afford to eat, pay the mortgage, property taxes, insurance on the house and car, etc. The choice was made for us, and they played it just right. The insurance companies know when people are coming into the poorer and probably sicker years, and, of course, they are in it to make money. Why not? They aren't doing it for love; they don't even know us. My hillbilly grandfather used to take his herbs to treat his neighbors if they wanted his help. Back then and there, the country doctors were few and far between and it was sometimes a day's ride by horse and buggy to even get to a doctor. If the patient was too sick to travel, they were sometimes dead by the time the doctor got to them. My uncle, five years old at the time, died of meningitis in this way. My grandfather, knowing his herbs could not "fix" this illness, rode a mule all day to reach the only available doctor, then it took the doctor another day to arrive at their house. It was too late, and imagine the pain of being told "if only you had made it just one day sooner." Yes. It was, and is, bad to be poor, but the poor are not necessarily bad or deserving of death or deprivation of simple necessities. That was a different time, of course.
Having said that, we are putting aside money to pay if we break a leg. I suppose we will not call upon the medical establishment to waste their radiation on us in case of something malignant or the other. I do not feel that anyone owes us ANYTHING for free; I do think that the cost of medicine in general as for most things has become greedily criminal, spurred on by greed in all quarters. I am almost 59 yrs. old. God has been gracious to allow me to be able to realistically count my years and realize that we don't live forever in this realm. So far, we have been able to pay our bills.
Glad to hear an expert say this.
The numbers I've seen in the past have it as 15-20% of medical costs are due to administative overhead.
In Canada its something like 3%, nt because it's socialized but because there's only one set of forms and rules.
If you're ever in Ohio I know a great doctor who might help you out.
Philosophically, one is born and then sh** happens.
So the CEO won't leave for greener pastures, leaving the hospital in charge of a less qualified CEO, ultimately costing patients, insurers, and taxpayers a lot more than it costs to pay the current CEO a market rate for his skilled services.
I'm questioning the "market rate" for a hospital CEO's services....just as the public is questioning the salaries of corporate execs.
I've seen the salary of one hospital CEO because I administered his executive compensation life insurance plan (the hospital's "golden handcuffs").
It's an investment of the hospital to the CEO so he won't fly to greener pastures.
I understand some people don't have much choice, but these people did. It is a tragic situation, no doubt, but that doesn't mean their bill should be forgiven.
A modest cape-style house in their region is most likely valued at over a quarter million. They probably have it mortgaged to the max already if they decided to drop their insurance coverage. I don't think, like you, theat they should receive their medical services for free. No one should, except our military men & women while on active duty.
I feel for the lady, suffering with cancer and all. But why in the world didn't she and her husband work out some sort of payment arrangement with the hospital for any money owed on the previous treatments? Hospitals are more than willing to work with people on such things.
I agree....set up payments with the hospital...that should settle the matter.
I'm not a doctor,
and don't play one on TV,
but, hell, I'll give you
a thorough exam
and it would only cost you
a voka and lime . . .
But if your heart's set
on real doctors, check into
the new SimpleCare.
They're not every where,
but they have gotten some press
from the big news sites.
When they get bigger,
I'd certainly make them my
go-to type doctors.
Yep. When I practiced law, I worked on what was the biggest corporate bankruptcy at the time. I had to collect from people who had lost their jobs, but it didn't matter, they'd signed a note. The hospital is doing the same. Considering the woman's condition and continuing need for medical care, it looks bad, but she signed a statement of financial responsibility.
That said, there are low cost insurance plans out there. Do they have high deductibles? Yes, but considering the financial mess this family is in, I'm sure they'd rather be out the $1-5,000 deductible than to lose everything over hospital bills.
Sadly, if they are ruined financially, maybe the couple can go on assistance and the taxpayer will end up paying for everything.
You are comparing apples and oranges. In your case, the original doctor did mess up. If you want to, then sue him.
In this case, the couple had ample opportunity to make payment arrangements with the hospital after the first treatment was over. It's been almost a year since those treatments were completed. They need to pay for services rendered.
Good alternative.
I always thought your home was secure and that they could not take that, even when you filed for bankruptcy.
Making them pay the bill is reasonable. The services were rendered and it is their responsibility to make sure the provider is paid.
The 4% daily interest, however, is a load of crap. It practically ensures that the couple will be paying this bill for the rest of their lives.
>>Hmmm . . . I have PLMD and RLS, so I do see a neurologist
>>whose name I bet you'd know.
>>$130 office visits are just insane, even if insurance
>>DOES cover the rest of it. Nothing happens to me in my 30 >>minutes in that office that costs the doctor more than
>>$10, and that's all labor, and way jacked-up if you
>>consider the sum total of the labor involved is to whack
>>my knee with that little rubber axe..
I figured that it was about time to get this off of general viewing.
I could see you but it's outside of the stuff I generally deal with. I just checked on the physician fee schedules- you can do it yourself here
http://www.cms.hhs.gov/providers/
though it's hardly a user friendly site. For an office consultation level IV- new patient high complexity (99244) Medicare reimburses $177.13. For an established outpatient visit you would probably fall into a level III (99213)- $53.76 or level IV (99214)- $84.36.
$130 does seem a bit much but if we were to use the $10 figure that you gave the MD would be bringing in $41,600 a year before taxes and overhead (office space rent and employees) assuming one patient every half hour for eight hours a day, five days a week, fifty-two weeks a year and no cancellations.
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