She said that she was "grateful" to the Hopkins surgeon who "saved my life" but that she and her husband, Charles, got by on $1,080 a month from Social Security and $152 in food stamps. "I have a little checking account that I pay my bills from. There is a little over $1,000 in that; so you see I'm in no position to pay all this money for the hospital bill," she wrote.
A month later, White asked the hospital again for financial aid, but was told the bills were "too old" to be eligible, according to hospital records.
Fearing she could lose her home, White accepted terms outlined over the phone by the hospital's attorney to keep a court judgment off her record. Hopkins spokesman Gary Stephenson said Friday that the hospital "recognized a mistake had been made" but would not elaborate. He said the hospital had returned all the money she had paid with interest.
No standard policies
White's plight illustrates how standards and practices for offering charity care vary among hospitals, and how the court system can overwhelm patients.
Hospital association officials said all of their members, at a minimum, offer free care to patients who have less than $10,000 in net assets and incomes below 150 percent of federal poverty guidelines, set this year at about $33,300 for a family of four.
But the association has resisted efforts by Maryland lawmakers to standardize those policies. As a result, they vary significantly, even among hospitals that serve some of the same areas and populations. For instance, patients at Bon Secours Hospital Baltimore may be granted free or reduced-price care with income of about $42,000 for a family of four. At Maryland General Hospital, about than two miles away, income levels to qualify are about $11,000 less.
The situation gets even more complicated when a person owns property, is employed, or has assets such as a bank account. To hospitals, that can signal that a person may be able to shoulder some if not all of the bill. On the other hand, someone with a higher income may be judged unable to pay if the bills are large enough.
"There is as much art as there is science" to determining who is eligible for charity care, said Jeff Karns, director of patient financial services at Peninsula Regional Medical Center in Salisbury.
Maryland Hospital Association guidelines dating to September 2003 require each hospital to "clearly communicate" their policies and to "re-evaluate the patient's financial condition" prior to suing over an unpaid bill.
