Financial Assistence Policy (charity Care) or Medicare ABN. The two do not conflict.

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By Gene Desotell on Saturday, September 19, 2015 at 7:43am

On 9/17/15 3:19 PM, Jen Flory wrote:

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Hello Mr. Desotell,

Apologies for any confusion. Through some mystery of telecommunication, the number that displays when I call out is not always my desk line - my direct line is listed below.

I do recall our conversation. The ABN does present a minor problem as the hospital now has more or less of a contract that it is relying on and someone uneducated in the hospital's other obligations might thing it controls. Nonetheless, because the hospital failed to follow the law around charity care and its own written policy that indicates that screening for financial assistance is the responsibility of the admissions department (https://syfphr.oshpd.ca.gov/SearchData.aspx?aid=11142&subtype=41&data=1 ) (assuming this is the same hospital), you should be able to contest the ABM as the patient was not advised of her rights as required by the hospital by law.

In terms of the California law, (most of it is here: http://www.oshpd.ca.gov/HID/Products/Hospitals/FairPricing/HSC127400_CharityCarePoliciesSB350.pdf, though it was amended last year to add some additional collection protections: http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB1276&search_keywords=hospital+fair+pricing or if you have access to the updated CA Health & Safety Code, just start w/ section 127400), we've really only been able to enforce it via raising affirmative defenses to collection lawsuits, and as far as I am aware, those generally settle successfully out of court. We have had real difficulty getting Licensing & Certification to do anything as they consistently tell us they receive no complaints. I think you have their info, but in case you don't, it's here: http://www.cdph.ca.gov/PROGRAMS/LNC/Pages/LnCContact.aspx

The tactic most of our advocates have used is to write a strongly worded letter to the hospital head of financial services, cc'ing the person handling the bill and anyone else deemed necessary (CEO, whomever), citing all of the violations of the Hospital Fair Pricing Act (failure to screen, etc.), informing them that you are complaining to Lic & Cert, and now as you mentioned, that we have IRS regs for non-profit hospitals, informing the hospital that you intend to report them to the IRS. Also point out that neither the Hospital Fair Pricing Act or the IRS regs have any residency requirement. I would also recommend filling out the charity care application (on this website: https://syfphr.oshpd.ca.gov/ ) and sending that along w/ proof of income w/ your letter. That really gives the hospital little to fall back on since they have all of the info needed to make a determination and adequately demonstrates that trying to collect from someone with such low income is pointless.

I am disappointed you got such poor service from Licensing and Certification, but not surprised.

Hopefully you are able to resolve this for the patient you are helping before she is subject to any stressful collection notices or a collection action.

Best,

Jen Flory
Senior Attorney
WESTERN CENTER ON LAW & POVERTY
1107 Ninth Street, Suite 700
Sacramento, CA 95814-3600