Also appearing in the 20 October 2013 Sunday Denver Post

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In recent months, government disclosures of hospital charges have parted the curtain on vast disparities in the cost of routine services and procedures, from X-rays to aspirin.

But a two-night hospital stay for a broken leg offered me unwelcome entry into a whole other realm of hospital overcharges that remain secret and invisible to taxpayers–despite costing the U.S. hundreds of millions of dollars in tax revenues.  These are the charity write-offs taken by nonprofit hospitals, used to justify their tax-exempt status.

I was just 11 months shy of being eligible for Medicare when I fell and ended up at St. Anthony, a new $375 million hospital outside Denver that is part of the 15-hospital Centura Health Network.

St. Anthony is a faith-based nonprofit organization. I trusted “faith-based.” To me it represented the hand of God.

But I had no insurance and only a small home and a 1994 Subaru as assets. In my emergency room cubicle, bean counters bumped elbows with healers. Expert eyes diagnosed me immediately as an inconsequential pauper.

The surgery to fix my leg was repeatedly delayed for nearly a day. No food, no drink, Ice Chip City. But the well-oiled medical machine kept me tanked up on painkillers and oxygen, checked on me regularly and treated me well. I walk now with barely a limp, and for that, I am grateful.

After leaving the hospital, I was given the opportunity to prove my poverty. The bill plunged from $63,000 to $1,300. I sobbed with relief.

But then I started wondering: How had my bill become so large?

Centura has $2 billion in annual revenues, and says that because St. Anthony is a nonprofit, the hospital pours all of its revenue into its various health care and community benefit operations. In 2011, Catholic Health Initiatives-Colorado, Centura’s parent nonprofit, reported to the Internal Revenue Service that it provided $63,873,673 in uncompensated care for the poor. Centura’s mission is “not merely a business, it is a calling,” the organization’s website states. But I found nothing sacred in what I discovered: outrageous pricing, esoteric coding and disturbing accounting procedures.

St. Anthony charges $400 for X-rays, while an industry web site says that X-rays cost $2.50 to provide. My bill listed $22,000 in pharmacy charges alone, but that didn’t sound right. A web site devoted to medical costs by Zip Code said a broken leg, surgical repair and five nights in a hospital should run around $16,000. I spent only two nights, despite being pressed hard to stay longer.

The bill was baffling, studded with numbers that supposedly explained my treatment and its cost. I asked the hospital for something in plain English and instead received a duplicate of the original bill.

A friendly man at the American Medical Association offered to review the bill, but confessed confusion. He and his colleagues didn’t recognize the codes and said that charges labeled as procedures appeared to be supplies instead. “This bill needs a serious dose of transparency,” he said.

Through payment and negotiation, I got the bill for my care down to $775. Still, the hospital repeatedly pressured me to raise my monthly payments.

Robo-calls from the hospital were followed by emails from credit rating agencies warning that they had received negative information about me. When I called, Centura admitted that it had sent three of my five “accounts” to a collection agency. But it could “call them back” if I’d increase my monthly payment to $50.

Unfortunately, my Social Security check went down to $550 when I turned 65, a $110 monthly deduction to pay for Medicare. “You want me to send you $50 of this $550 monthly income?” I asked a patient representative.

Silence.

“Is there were anything else I can help you with?” she asked.

A look at Centura’s annual IRS filing shows that the nonprofit’s president collects an annual salary of $1.5 million, while the CFO receives $740,000 in compensation. The organization spends $1 million a year to a Swiss-based debt collection service, specialized at tracking down former patients across borders.

I contacted St. Anthony for comment on this essay. Within hours, my accounts were withdrawn from the collection agency, as were negative credit reports, and the hospital accepted the reduced payment plan. A later email reported that St. Anthony abides by all applicable rules and prices its services competitively.

Now it seems to me that St. Anthony — which kicks off each day with a reflective comment or prayer over the hospital intercom — takes advantage of the trust of its faith-based customers. The nonstandard codes are puzzling, the accounting games debilitating: The hospital’s leverage increases if it can send one “account” at a time to a collection agency, like a slow IV drip playing on the nerves of the consumer.

Most troubling is the exaggeration of charitable work, which gives St. Anthony tax advantages that ordinary taxpayers must subsidize. Hospitals sometimes get in trouble for this.

But as a hospital association executive put it: “One million charity patients? One million pieces of paper. Who’s going to look at them all?”

Rita Healy is a freelance writer based in Colorado. A version of this essay appeared in The Denver Post on 18 October 2013.

Rita Healy’s first article for 100Reporters was published in October 2013 (http://100r.org/2013/10/the-63000-broken-leg-or-how-hospitals-make-money-off-charity-care/). The experience formed the basis for her interest in producing this series.
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