While living in Detroit earlier this year, Brianna Snitchler wanted a cyst removed from her abdomen. But her doctor wanted the growth checked for cancer first. (Callie Richmond for KHN)
Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.
Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.
“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler, 27, said.
For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.
One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.
“People would always call it out and be alarmed by it,” she recalled.
Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System’s main hospital.
The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.
Then the bill came.
The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.
Total Bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.
Service Provider: Henry Ford Health System in Detroit.
Medical Procedure: Ultrasound-guided needle biopsy of a cyst.
What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.
Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.
“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”
Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.
In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”
“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.
The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.
Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.
But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.
“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.
Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.
In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.
Brianna Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.
With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.
Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.
Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.
A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.
In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”
He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.
Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”
In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.
For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.
“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”
“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.
The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.
Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.
If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
While living in Detroit earlier this year, Brianna Snitchler wanted a cyst removed from her abdomen. But her doctor wanted the growth checked for cancer first. (Callie Richmond for KHN)
Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.
Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.
“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler, 27, said.
For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.
One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.
“People would always call it out and be alarmed by it,” she recalled.
Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System’s main hospital.
The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.
Then the bill came.
The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.
Total Bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.
Service Provider: Henry Ford Health System in Detroit.
Medical Procedure: Ultrasound-guided needle biopsy of a cyst.
What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.
Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.
“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”
Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.
In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”
“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.
The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.
Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.
But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.
“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.
Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.
In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.
Brianna Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.
With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.
Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.
Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.
A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.
In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”
He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.
Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”
In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.
For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.
“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”
“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.
The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.
Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.
If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
The leaders of Pathway Church on the outskirts of Wichita, Kan., had no clue that the $22,000 they already had on hand for Easter would have such impact.
The nondenominational suburban congregation of about 3,800 had set out only to help people nearby pay off some medical debt, recalled Larry Wren, Pathway’s executive pastor. After all, the core membership at Pathway’s three sites consists of middle-income families with school-age kids, not high-dollar philanthropists.
But then they learned that, like a modern-day loaves-and-fishes story, that smaller amount could wipe out $2.2 million in debt not only for the Wichita area but all available debt for every Kansan facing imminent insolvency because of medical expenses they couldn’t afford to pay — 1,600 people in all.
As Wren thought about the message of Easter, things clicked. “Being able to do this provides an opportunity to illustrate what it means to have a debt paid that they could never pay themselves,” he said. “It just was a great fit.”
Churches in Maryland, Illinois, Virginia, Texas and elsewhere have been reaching the same conclusion. RIP Medical Debt, a nonprofit organization based in Rye, N.Y., that arranges such debt payoffs, reports a recent surge in participation from primarily Christian places of worship. Eighteen have worked with RIP in the past year and a half, said Scott Patton, the nonprofit’s director of development. More churches are joining in as word spreads.
The mountain of bills they are trying to clear is high. Medical debt contributes to two-thirds of bankruptcies, according to the American Journal of Public Health. And a 2018 Kaiser Family Foundation/New York Times poll showed that of the 26% of people who reported problems paying medical bills, 59% reported a major life impact, such as taking an extra job, cutting other household spending or using up savings. (Kaiser Health News is an editorially independent program of the foundation.)
The federal Consumer Financial Protection Bureau proposed a rule last month to curb debt collectors’ ability to bug those with outstanding bills, and some states have tried various measures, such as limiting the interest rates collectors may charge. But until a comprehensive solution emerges, churches and others are trying to ease some of the load by jumping into the debt market.
A big part of RIP’s appeal comes from the impact even a small donation can have, say participating church leaders. When a person can’t pay a bill, that debt is often packaged with other people’s debt and sold to bill collectors for some fraction of the total amount of the bill. Those debts usually come from low-income people and are more difficult to collect.
RIP Medical Debt buys debt portfolios on this secondary market for pennies on the dollar with money from its donors. But instead of collecting the debt, RIP forgives it.
To be eligible for repayment from RIP, the debtor must be earning less than twice the federal poverty level (about $25,000 a year for an individual), have debts that are 5% or more of their annual income and have more debt than assets.
Because hospitals and doctors are eager to get those hard-to-collect debts off their books, they sell them cheap. That’s how, Patton said, those 18 churches have been able to abolish $34.4 million of debt since the start of 2018.
Working this way puts a high-dollar project within reach of even small churches. Revolution Annapolis, a nondenominational Maryland church with Sunday attendance of around 200 and without a permanent building, wiped out $1.9 million in debt for 900 families in March. Total amount raised: $15,000.
Revolution leaders heard about RIP Medical Debt on a segment of John Oliver’s “Last Week Tonight” in 2016, said Kenny Camacho, lead pastor. But at the time, they didn’t think they had the resources to make much of a splash.
After hearing about another church that paid off millions last year, Revolution leaders decided to try it. At most, they hoped to have an impact in their area, Camacho said. But the money went much further, eventually covering 14 counties in eastern and central Maryland.
Emmanuel Memorial Episcopal Church, a congregation of about 175 families in Champaign, Ill., had a similar experience. The original idea was to try to have an impact just in Champaign County, said the Rev. Christine Hopkins. But their $15,000 abolished $4 million of debt for the entire diocese, which stretches across the southern half of the state.
“We were bowled over, actually,” Hopkins said. “It was to the point of tears.”
In many cases, churches have not had to do a fundraising campaign because their contribution came from money already on hand. Emmanuel Episcopal, for instance, had leftovers from a campaign set up a year ago to celebrate the centennial of its church building.
The Fincastle Baptist Church, with 1,600 members in the Roanoke, Va., area used money it had budgeted for an annual “Freedom Fest” event to honor first responders, and then partnered with local television station WSLS in a telethon to raise more. That effort abolished over $2.7 million in medical debt targeted at veterans.
The RIP nonprofit allows donors to choose geographic areas they want to reach and can pinpoint veterans as recipients. But beyond that, no restrictions are allowed, Patton said. A church can’t specify which types of medical procedures could be paid for or anything about the background of the recipients.
That didn’t bother church leaders contacted for this story. But it is a subject that’s been broached by donors of all types in the past, Patton said.
For instance, some potential donors have asked to exclude people from different faiths or certain political parties, he said. “It’s just absurd. This is not a revenge tactic,” Patton said. “People who are requesting those things really don’t understand philanthropy.”
Churches don’t necessarily experience a direct return in the way of new members. All the processing goes through RIP Medical Debt, which sends letters notifying the beneficiaries their debts have been forgiven. Donors can have their names listed on those letters, but not everyone opts to do so.
New membership wasn’t the point for Pathway Church in Kansas, Wren said. “Sometimes the more powerful spiritual message is when you’re able to do something for somebody that you’ll never meet.”
The Revolution Church decided against putting its name on the notification letters, Camacho said, because it didn’t want beneficiaries to feel obligated. “When a person has their debt forgiven, we want them to experience that as a kind of no-strings-attached gift,” he said. “We don’t want there to be any sense that because we did this now they should visit our church or something.”
Besides, he said, the gift covered an area large enough that some beneficiaries live a couple of hours away. “I would much rather them think more positively about the church down the street from where they live.”
Donors sometimes hear back from the people whose debts they’ve paid, but not often. Many don’t expect it. “I guess that’s a biblical story, too. Jesus forgave 10, and only one said thank you,” Hopkins said.
Churches have a lot of choices when it comes to charity, but medical debt and affordability issues often resonate with parishioners. Some churches are worried enough about medical costs for their members that they subscribe to cost-sharing nonprofits, in which members pay each other’s medical bills.
Medical mission work has long been an important form of outreach for Fincastle Baptist Church in Virginia, said associate pastor Warren King. The church runs a free clinic, and mission trips to other countries usually include a medical component.
Paying off medical debt is an extension of that line of thinking. “We need to do not just this thing but many things that practically show the love of God,” King said. “It’s hard to tell somebody God loves you if they’re starving and you don’t try to deal with the problem.”
Hopkins said the debt outreach was a satisfying project for her Illinois congregation because it could resolve a problem for the beneficiaries. “We do a lot of outreach that’s food-related and housing-related. This was something different,” Hopkins said. “You help feed somebody, and you’re feeding them again the next day. This was something that could make an impact.”
