Kathleen Quader never expected a trip to the emergency room would land her in a courtroom.
Quader was sued by Danbury Hospital for unpaid medical bills totaling $6,621. Quader said she was never trying to avoid payment, but the legal fight took three years to resolve.
It all started in October 2016 when Quader received a call from her teenage daughter, Emily, who had been in a crash.
At first Emily didn't want to go to the hospital, but her mom insisted. Emily was diagnosed with a concussion.
"They ran some tests, they did a CAT scan, made sure that she was ok," Quader said.
Quader initially gave the hospital her car insurance information. She said almost a year went by before she found out the claim was rejected. At that point, Quader said she provided her medical insurance. The next time she said she heard from Danbury Hospital, it was to notify her she was being sued.
"I couldn't understand how I could be sued if I had insurance to pay for that bill," she said.
Quader found out her health insurance provider rejected the claim because it was filed more than 90 days after treatment.
What happened to Quader is not unusual. Data analyzed by researchers at the UCONN Health Disparities Institute show Danbury Hospital has filed suits against thousands of its patients.
Dr. Victor Villagra and his team looked at small claims cases filed by 28 acute care hospitals in Connecticut. In 2015 and 2016, nearly half of those cases were brought by Danbury Hospital.
"It's impossible not to notice," Villagra said. "You have 27 other hospitals that are nowhere at that level of activity."
His research shows the court rules in the hospital's favor 99 percent of the time.
"We already knew that the majority of people don't show up [for court,] Villagra said. "Of course when the patient or defendant does not show up, it's an automatic ruling against them and they have to pay one way or the other."
Kathleen Quader was determined to fight her lawsuit. After the first hearing, the hospital offered to settle for $5,500.
But Quader rejected the settlement.
"Never give up when you know that you're right," she said.
A friend suggested Quader contact the Connecticut Insurance Department. After reviewing her case, the department directed Quader's insurance company to pay the claim. Once payment was received, Danbury Hospital dropped the lawsuit.
Danbury Hospital operates under Nuvance Health. In a statement to NBC Connecticut, a spokesperson said, "Court filings are only utilized as a last resort. In 2018, of our hundreds of thousands of encounters, only approximately 0.2% led to court filings. These filings come only after months and even years of outreach goes ignored. The filings are only made against an individual who has assets and/or income. "
The spokesperson went on to say, "Our collection practices have always been based on a desire to treat people fairly and at the same time recover money that is owed to us. This report [by the UCONN Health Disparities Institute] has identified that our practices need to be modernized and we have already begun to make those changes.
The Connecticut Office of Health Strategy says it is also reviewing Danbury Hospital's collection practices.
A spokesperson said OHS cannot comment while the review is underway, but did address what the state is doing to address the rising cost of health care.
“Governor Lamont signed an executive order… that directs OHS to establish a healthcare benchmark. Essentially that is working with providers and advocates to put limit on how high costs can grow per year—for states that have done this it is indexed to other consumer costs.”
Unaffordable Health Care?
Dr. Villagra’s research shows the majority of people who fall into medical debt are what’s often referred to as “underinsured.”
"They are fully insured, but with deductibles going up at the rate they're going with high-deductible plans, people simply cannot afford these charges," he said.
The number of people enrolled in high-deductible health plans (HDHP) spiked between 2007 and 2017 according to the National Center for Health Statistics, accounting for 43.7 percent of private plans.
In exchange for lower monthly premiums, policyholders have to pay a certain amount out of pocket before their insurance kicks in. That typically happens around mid-May. And Villagra said it can result in patients putting off medical care.
“The root cause of this is the high prices that we’re all being charged for an emergency room visit, a day in the hospital,” Villagra said.
Villagra said health insurance literacy also plays a role. He surveyed Connecticut residents about 13 basic health insurance concepts, including premiums and provider networks. Statewide, 62% of respondents answered correctly. The percentages were lower among minorities.
“These plans are so complex that nobody can understand it fully,” Villagra said.
He has presented his findings to the Connecticut High Deductible Health Plan Task Force, which is looking for solutions.
For plan year 2020, the minimum deductible for an HDHP is $1,400 for an individual and $2,800 for a family.
