Response to "A Troubling Question"

On May 4, 2009, I posted a complex question which asked for my response. I asked for comments from readers but received none. Here are the facts presented:

"Patient: has worked in health care as an R.N. for 27 years; was required, by the employer to join a union for health care benefits; received great health benefits until a decline in health necessitated multiple transplants in the period of one year; maxed out the lifetime benefits allowed; desired to return to work but still owing much in medical expenses related to transplant; told by employer that because unionized no further benefits were allowed, whereas if not unionized benefits could be restored; back working and making a substantial salary once again; still no way to pay off former medical expenses; does not qualify for any "programs" to assist.
Double edged sword here? What is the answer for people like this who have worked, and paid into the system, and desire to keep working but for unforeseen circumstances have encountered medical costs that are way beyond reach?"

The general approach to issues such as this is to question every element of every bill as to accuracy, completeness, veracity, failure to record all payments, failure to pass on discounts to patients. Make no assumption that charges or payments are correct because they often are not.

Because I have retired from law practice, I cannot give specific advice to the questioner. However, I recommend that you contact Peter Liebold, the executive director of the American Health Lawyers Association (202-833-1100), and ask for the names of several attorneys in your area who are experts in health care law dealing with the issues you described. In addition, you can contact your local bar association, your state bar association or even the American Bar Association to learn the names of attorneys who may help you. You might find a competent health care attorney who would be willing to provide pro bono" services, though that is not very likely.

My own experience, when I sat on committees reviewing charges by hospitals and their business associates, physicians and other providers was that there were often major discrepancies between services and products actually rendered and listed, and what should have been charged and what was charged. And on the other side, there were discrepancies in insurance company payments. Some insurance payers got special discounts which were not always passed on to patients and their families, whose bills were improperly inflated as a result. So it might be worth your while to request that your union to which you have paid dues for years - at its expense - obtain an expert audit of all charges and payments in your complex situation. If the union won't do it, you may find free legal assistance organizations in your area who might advice you on obtaining an audit at no cost to you. Sometimes, a non-profit charitable association dealing with particular diseases may have resources, and you may wish to contact the organ transplant association dealing with your problem to ask their assistance in obtaining an audit.

There are laws which protect insurers and employers from the consequences of decisions which may be disadvantageous (or sometimes injurious) to employee patients and their families. But some of these employer/insurer protection laws may not apply to your situation, as a competent health law attorney can determine for you.

You and your attorney may be able to negotiate a fee reduction based upon your financial hardship if you were dealing with a non-profit transplant center, hospital, and providers. After all, such institutions obtain tax benefits for their charitable services and the Internal Revenue Service might be interested in your experience with an institution which did not fulfill its charitable obligations and played hard-ball with you.