But the Plan Is Buried, Hard to Understand and Offers Less Than Meets The Eye
Sentara Healthcare has amassed $6 billion in net assets in part because it pays no taxes. That means its tax status and much of its finances are underwritten by Hampton Roads taxpayers.
All nonprofit health care companies such as Sentara must have financial aid plans for low-income and uninsured patients in order to preserve their status under section 501c3 of the U.S. tax code. These plans must be accessible on the company’s website, which is where we tried to find Sentara’s.
But if you’re a low-income or uninsured taxpayer who becomes a Sentara patient during a medical emergency, here’s what you will have to do to access and understand its benefits:
Dig deeply into the Sentara’s website to find its financial aid plan. It takes at least five clicks from the company’s home page to a search engine and then back to the main website to find the plan.
Develop on the spot the expertise in health care finance and technical terms to find definitions of the arcane terms used by Sentara to describe these types of medical services.
Have the determination to withstand attempts to collect on your bill that have the potential to wreck your credit rating.
Sentara Healthcare routinely boasts of its commitment to providing charity care. However, a review of its financial aid plans indicates it charges those who are least equipped to pay higher rates than those with insurance to help pay their bills.
Hard to find
If go to the Sentara home page — https://www.sentara.com/hampton-roads-virginia/ — there’s no direct link to the financial assistance page.
What about the website’s search function? Well, a search for “financial assistance” yields nothing.
Instead, a patient is better going to Google and searching for “Sentara financial assistance,” which yields this page: https://www.sentara.com/woodbridge-virginia/billing/financial-assistance/sentara-halifax-regional-hospital.aspx
Near the bottom of the page are links to the Sentara financial assistance policy and the applications for financial aid.
A patient who knows that the plan exists can call the Sentara’s financial aid coordinator, whose contact information is listed on the aid application. When asked about the terminology used in Sentara’s financial assistance policy, a representative at the financial aid office referred our call to the company’s marketing department.
Hard to decipher
Once a patient finds the financial aid policy, he or she discovers a thicket of health care bureaucratese that can deter even the most hardened researcher.
Patients are confronted with terms such as “facility gross charges” or “amounts generally billed” that refer to what types of discounts they may receive.
Patients eligible for a 100 percent discount of “gross charges,” which is the full amount a hospital charges for a service, must make up to 300 percent of the federal poverty level, which is $38,640. But they must not have more than $50,000 in available assets.
Available assets are defined as “total amount of assets available. That includes any liquid and/or fixed assets for use in paying for medical care including, but not limited to: cash and cash equivalents, bank accounts, certificates of deposit, investments, trust accounts, automobiles, recreational vehicles and other forms of leisure transport, and real estate equity in real property other than the principal place of residence. Specifically excluded from Available Assets is the equity in an applicant’s principal place of residence, primary source of transportation, IRS recognized retirement savings accounts, business assets, and 3.99 acres of land.”
A patient who makes more than 400 percent of the poverty level is eligible for what Sentara calls a 50 percent “self-pay” discount. But if you want to learn about that, you have to look for the separate “self-pay discount” page, which entails another search.
Once there, the patient learns that any uninsured patient can get the discount whenever the bill is generated. But, as Checks & Balances Project has learned, the amount listed on the bill for a discounted service can be much higher than the price Sentara lists for uninsured patients.
What Sentara says is a favor for uninsured patients really isn’t much of one at all.
The IRS requires any hospital with nonprofit, tax-exempt status to limit how much it charges patients who need financial help.
Patients eligible for help under a hospital’s financial assistance plan must pay no more for a service than the average of what the hospital bills an insurance company for that service. At most hospitals that “amount generally billed” is between 28 and 33 percent of the gross charge.
The IRS says the limiting of charges to any patient who needs help should have little to do with whether they have insurance or not.
So, why does Sentara assert it offers such a discount to certain uninsured patients when they actually inflate the prices they’re charged?
We asked that question to Danya Bushey, Sentara’s spokeswoman, who did not respond.
Perhaps the IRS and Treasury Department, which monitor the compliance of tax laws will have better luck finding the answers.
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Ray Locker is enterprise and investigative editor of Checks and Balances Project, an investigative watchdog blog holding government officials, lobbyists, and corporate management accountable to the public. Funding for C&BP is provided by Renew American Prosperity and individual donors.