Amelia remembers crying in her bed at Lenox Hill Hospital after having an emergency C-section in late 2013 while her son was being cared for in the neonatal intensive care unit.
“I was just sobbing in the hospital and they thought I was depressed over the baby,” recalls Amelia, who had to give birth prematurely because she had a life-threatening complication known as preeclampsia. “They wanted to call a psychiatrist. I was like, ‘No, I’m going to have medical bills. That’s why I’m crying.’” (Amelia asked that we not use her real name for this story, citing privacy and legal concerns.)
At the time, Amelia’s insurer, the now-defunct Freelancers Insurance Co., was refusing to cover the cost of her baby’s care, which she says left herwith more than $100,000 in medical bills after leaving the hospital.
This was the start of an odyssey through the medical billing system that culminated with Lenox Hill suing Amelia in 2017 for $9,695 -- the amount the hospital said was left of her debt nearly four years after she gave birth.
“I don’t hold it against them,” says Amelia, who works independently as a physical therapist. “I’m a health care professional and I want to get paid for my work. But the effect on an individual is terrible.”
Amelia’s is just one of nearly 31,000 cases of patients being sued by New York hospitals between 2015 and 2019 that the Community Service Society of New York analyzed in a new report released Thursday. CSSNY culled the lawsuits from the state’s eCourts public database. As the report notes, patients are getting sued for medical debt by nonprofit hospitals as insurance premiums and deductibles rise to increasingly unaffordable levels. And it doesn’t necessarily take a lot for a hospital to take a patient to court: The median amount hospitals sought to recover through the lawsuits was $1,900.
Northwell Health--the massive hospital network that includes Lenox Hill--takes the title of the health system with the most lawsuits filed against patients. CSSNY calculated that Northwell was responsible for about half of the 31,000 lawsuits analyzed, although in reality it may be closer to a third.
Northwell contested CSSNY’s assertion that it’s responsible for the 5,546 lawsuits that were filed by Crouse Health Hospital in Syracuse during the time period considered, since the hospital is just a clinical affiliate of Northwell and isn’t owned by the health system. It also says it’s not responsible for lawsuits filed by affiliate Maimonides Medical Center in Brooklyn, which sued 21 patients. In calculating the lawsuits filed by other health systems, CSSNY similarly attributed suits filed by affiliated hospitals as well as those fully owned by the networks.
Either way, Northwell hospitals are taking a lot of patients to court, says Elisabeth Benjamin, vice president of health initiatives at CSSNY. “I don’t know any other nonprofit charity out there that’s suing 10,000 people,” she said.
“Northwell Health does not file lawsuits on 99.9% of its patient bills,” a spokesperson for the health system said Wednesday. “In the rare instances that Northwell Health takes legal action, it occurs only when a patient has been unresponsive to the multiple attempts made by Northwell Health to resolve the outstanding balance (including multiple offers for financial assistance, discounts, and counseling) and the patient has a strong ability to pay the outstanding balance.”
Many of the cases CSSNY analyzed revealed stories of patients being sued after getting hit with the kind of unexpected medical bills Gothamist, WNYC and ClearHealthCosts have been investigating through our project #PriceCheckNYC. And many said they didn’t have the means to pay.
One Queens man who settled with Lenox Hill agreed to pay the hospital $1,000 in $50 monthly installments. He said in his response to the lawsuit that he was at the hospital after his partner was raped and staff “insisted” on testing him for HIV even though he didn’t have insurance. “I could have went to my doctor and had it done for $200 to $300,” he wrote. “I should not be responsible for this. I cannot afford this.” As CSSNY notes, he also could have been directed to one of the facilities that does free STD testing in Queens.
In response to a lawsuit filed by NewYork-Presbyterian’s Lower Manhattan Hospital, a Manhattan woman wrote, “I have no health insurance and a heart arrhythmia...I have proof of three payments [to] downtown presby. I work at a bar and don’t have much $.”
Documents attached to her case show that the damages the hospital sought of $2,282.62 included $500.51 in interest at a 9 percent annual interest rate.
For many people, medical debt has serious consequences, even without facing a lawsuit. Amelia says she stopped working as a physical therapist for a while because, “It was either I’m going to work and give all the money to the hospital or I’m going to quit my work.”
Eventually, the Freelancers Insurance Co. agreed to cover her son’s care retroactively, but amid the company’s 2015 shutdown, Amelia says it took years for all the money to come through. In the meantime, she says she received frequent collections notices.
Nationwide, it’s not uncommon for hospitals to sue patients over medical debt. But some of the New York hospitals that sue patients most frequently also fall short on the amount of financial assistance they offer, earning more in government subsidies for charity care than they actually provide to patients, according to CSSNY.
Lenox Hill, for example, filed 1,186 lawsuits against patients for medical debt between 2015 and 2019. Meanwhile, in 2018, the hospital received $1.6 million more from the government-funded Indigent Care Pool than it distributed in financial assistance, according to data CSSNY received from the state Department of Health through a Freedom of Information Law request.
According to CSSNY’s data, this is true of several Northwell hospitals. Northwell countered that, systemwide, it provides more charity care than it receives compensation for from the Indigent Care Pool.
“Northwell Health has, for over a decade, offered financial assistance to its patients based on income levels up to 500% of the federal poverty level (FPL), well in excess of the New York State requirement of 300% FPL,” a health system spokesperson said. “Northwell Health makes its Financial Assistance Program well known to its patients through signage at its patient care locations, website, and through its billing statements.”
Northwell added that hospitals should not have to take on the cost burden insurers are trying to shift to patients through higher deductibles.
CSSNY says hospitals aren’t taking their charitable missions seriously enough and is pushing for changes at the state level to make patients less vulnerable to getting sued over medical debt. The Patient Medical Debt Protection Act, pending in the state legislature, would reduce the maximum interest rate for hospitals pursuing medical debt to 3 percent annually and would shrink the window for hospitals to file suit from six to two years. It would also create a standardized hospital financial assistance policy.
“The lack of a statewide uniform Hospital Financial Assistance policy ensures that patients are kept in the dark about how best to defend themselves against hospital medical debt,” the report says.
In the overwhelming majority of the lawsuits CSSNY examined, the patients being sued did not have lawyers and many ended up with default judgments.
In a sense, Amelia was one of the fortunate ones: She got her case dismissed, rather than having to settle. The judge noted that the Freelancers Insurance Co. finally sent Lenox Hill a check for its remaining balance of $6,463 and said the hospital should take into account Amelia’s eligibility for financial aid before pursuing the rest of her medical debt.
You can share information about what you have paid for recent medical services—and search for the cost of a given medical procedure at different health care providers in your area below. You can also email us your tips at [email protected] and read our other #PriceCheckNYC coverage here.
Support for this work was provided by the New York State Health Foundation (NYSHealth). The mission of NYSHealth is to expand health insurance coverage, increase access to high-quality health care services, and improve public and community health. The views presented here are those of the authors and not necessarily those of the New York State Health Foundation or its directors, officers, and staff.
