OR Nonprofits Impede Patient Access to Financial Assistance Programs

Oregon nonprofit health systems are failing to comply with state laws and engaging in practices that make it difficult for patients to access financial assistance programs and avoid medical debt, a report from SEIU Local 49 found.

In 2019, Oregon passed legislation aimed at protecting patients from medical debt and ensuring nonprofit hospitals are following their charitable responsibilities.

However, the state’s largest healthcare system, Providence Health & Services, has undergone legal scrutiny following allegations that it enacted policies and practices that willfully disregard financial assistance rules and deny assistance to eligible patients.

In February 2022, the Washington State Attorney General filed a consumer protection lawsuit against Providence. The Oregon Department of Justice also recently launched an investigation into the health system’s financial practices.

In response to these complaints, SEIU Local 49 reviewed the policies of ten of Oregon’s largest nonprofit health systems to determine if suppressing financial assistance information is a widespread issue. The union discovered that most of the health systems were not complying with Oregon laws and were employing practices that created barriers to receiving financial assistance.

Finding and understanding information about financial assistance at the hospitals is not an easy feat for patients, the review found.

For example, despite legal requirements that hospitals widely publicize financial assistance information, the only reference to financial assistance on Providence’s homepage was in a menu at the bottom of the page. After clicking the link, patients are left with a new page offering options to pay a medical bill or a premium payment. Also at Providence, staff received specific training about how to avoid telling patients about the availability of financial assistance.

Oregon law requires nonprofit health systems to extend their financial assistance policies to clinics they own to cover care received in outpatient settings. The ten nonprofit health systems all used vague language, making it difficult to understand this policy.

Only two systems made it known that services at clinics are included, two systems said only that hospital services are covered, and other systems were not clear on their policies, the report said.

Oregon law also says that household income is the only qualification for financial assistance. But five health systems included restrictions based on where patients lived, with exemptions for emergency care.

Some health systems restricted provider groups or facilities from their financial assistance policies. The most common restrictions were for providers not employed directly by the hospital, including emergency department physicians, anesthesiologists, and hospitalists.

The health systems have also created barriers to financial assistance by having complex application processes. Most of the systems seemed to only accept applications by fax, mail, or in person, despite being able to pay medical bills online. Only two health systems offered online applications.

In addition, many applications were outdated or requested an unnecessary amount of information. Only two health systems had an application that was fully compliant with Oregon law. Some systems have even created their own forms that ask for additional information about household finances.

Eight health systems also asked patients to provide information about their assets on financial assistance applications, even though this information is optional per Oregon law.

Six health systems have also been violating federal law and sending bills to collections in 120 days instead of waiting 240 days, which is the time patients have to apply for financial assistance. When bills are sent to collections before the opportunity to apply for assistance has passed, patients tend to assume they can’t receive help anymore.

The review found that one of the health systems, St. Charles, sends patient bills to collections or continues collection actions even when a patient’s financial assistance application is being processed.

SEIU Local 49 recommended Oregon leaders conduct audits of the state’s nonprofit hospitals and determine how patients are made aware of financial assistance programs, if health systems are using assets to determine eligibility, and how systems use patient data to grant financial assistance.