Last week, the Orlando hospitals that treated the victims of the Pulse nightclub shooting announced that they are waiving those patients’ medical bills.
Others welcomed the announcement as well. Comments flooded an Orlando Sentinel Facebook post when the news broke.
“That is awesome! They have suffered enough and will for a very long time. They don't need to be stressing over a hospital bill. Two thumbs up to the hospitals,” one person wrote.
But amid the applause was uneasiness. Why should anyone have to pay for getting shot?
Writer and activist Dan Savage called the announcement “a feel bad story disguised as a feel good story.”
“There are people who were shot in Orlando around the same time, maybe even on the same night (this is America), who are also facing crushing medical bills,” he wrote in the Portland Mercury. “But their bills won't be forgiven because they didn't win an extremely perverse lottery.”
Victims of lower profile shootings — and other tragedies like accidents and illnesses — are stuck with bills that reflect the inadequacy of our healthcare system, Savage argued.
Relief from medical bills
There is some recourse for people facing staggering medical debt.
Under the Affordable Care Act (ACA), nonprofit hospitals are required to offer financial assistance to eligible patients.
Officials at Orlando Health, which operates the nonprofit hospital where most of the Pulse victims were treated, told Healthline that it “routinely” handles appeals for financial aid from patients.
“That’s not new for us. What is new is the scale and scope of this tragedy,” said spokesperson Kena Lewis.
Last fiscal year, Orlando Health gave out $63 million in charity care, Lewis said.
It expects to shoulder about $5 million in costs associated with the Pulse shooting, although it will seek to recoup some of that loss from “state and federal funds, private insurance, disability insurance, Florida’s crime victim compensation program, funding sources established for individual victims,” and Medicaid.
Florida Hospital, which treated fewer Pulse victims, said it will not even charge patients’ insurance providers.
‘Charity care’ not uncommon
Such relief from medical bills isn’t necessarily uncommon.
“The provision of essential community health services and the provision of free or discounted care based on financial need, community need, and input are some of the many ways healthcare organizations serve their communities,” Richard L. Gundling, a vice president with the Healthcare Financial Management Association, told Healthline.
According to the American Hospital Association, “uncompensated care” cost hospitals almost $43 billion in 2014, amounting to slightly more than 5 percent of total expenses. Uncompensated care includes charity as well as outstanding debts.
Pat Palmer, founder of the Medical Billing Advocates of America, says that many patients don’t know about the possibility of charity care or other services meant to ease financial burden.
“We have to get more education out to the public on what they need to do in order to lower their healthcare costs because nobody else is going to do it for them,” she told Healthline.
Intimidating medical bills may seem rigid, but they can actually be negotiated down, Palmer said.
She recommends that patients request itemized copies of their bills so they can assess each charge being levied. Often, these charges are inaccurate or duplicated. Uninsured patients or people treated out of network should also inquire about discounts.
Help is there for the taking but “if you don’t ask it doesn’t happen,” she said.
Ongoing healthcare costs
Although it’s rare for a medical payer to write off the expenses from a specific incident, it’s not without precedent.
In 2013, Boston-area hospitals and insurance companies pledged to cover the out-of-pocket costs of victims of the Boston marathon bombing. More than 260 people were injured in those blasts, including 16 who lost limbs.
Representatives from Tufts and Blue Cross Blue Shield Massachusetts told Healthline that they stayed true to that commitment.
Neither, however, provided information on the costs of ongoing care for these patients, such as physical therapy and mental health services.
That’s something that the Orlando providers could not promise.
“We can’t predict the future needs of these patients, their financial situations, or what the state or federal governments may require us to do for charity policies. So, while we can’t assume the answer is free care forever, we will use our very generous charity and financial assistance policies to assess the best way to ensure our patients get quality care here at Orlando Health in the most fiscally responsible manner,” Orlando Health representatives said in a statement.