A new report finds big hospital systems in Colorado don't adequately tell consumers about their rights and access to discounts, claims the state’s hospitals dispute.
The report from the nonprofit Colorado Consumer Health Initiative (CCHI) found less than 60 percent of hospitals fully meet the requirements of the Hospital Discounted Care (HDC) law, which the legislature passed in 2022, in a push to make bills more affordable for low- and moderate-income residents.
Under the law, hospitals need to inform patients of their rights, screen them to see if they qualify for financial help and offer discounts to patients who do.
CCHI examined websites and made phone calls in English and Spanish to 89 hospitals.
Fifty-eight percent met requirements like posting a “uniform application, the English-speaking patients' rights, the Spanish-speaking patients' rights, linking from the landing page to hospital discounted care information, and posting the information in a conspicuous manner,” according to a press release.
When “sample patients” from CCHI made phone calls to hospitals inquiring about discounted care options, 11 percent gave adequate information.
Of nearly 180 calls, 20 resulted in what the group called a “successful outcome,” i.e. the caller was able to get helpful and correct information about HDC. The percentage was much lower for calls made in Spanish (4.5 percent vs 18 percent for English-language).
“Information was out there, but absolutely not at the level we want it to be,” said Sophia Hennessy, CCHI policy and research coordinator, in an interview. “I think our report is really just focused on, ‘Is there information out there for consumers about this law we have here in Colorado?’ And the impetus for this report was really rooted in people having a hard time with medical bills.”
The HDC law requires hospitals to screen uninsured patients for eligibility for state-run programs, like Health First Colorado (Medicaid), and Children Health Plan Plus. They must also provide care at a discounted rate to anyone with a household income below 250% of the federal poverty line, which is roughly $3,137 per month for an individual and $6,500 per month for a family of 4.
The view from hospitals
A spokeswoman for the Colorado Hospital Association said hospitals do try to abide by the law and provide financial help for those who need it, at sharply rising rates, in part because hospitals are following the discounted care law.
“Hospitals work diligently day in and day out to comply with both state and federal laws,” said Julie Lonborg, senior vice president and chief of staff of the Colorado Hospital Association, in an interview. She said that the last six years, according to CHA’s accounting, that includes 542 new laws from the state of Colorado that impact hospitals. “So it's a big task when we look at it and we work really hard at it every day.”
Lonborg took issue with the phone call section of the CCHI report, saying those calls are not part of the regulation, something the nonprofit itself notes on page 12 of the report: “While there are no regulations on phone calls in Colorado’s HDC law, we chose to call hospitals to measure consumer experience accessing information about HDC from facilities.”
“There's nothing that is a rule or regulation in the statute about how phone calls are to be handled,” Lonborg said.
Lonborg said because of HDC, many people are now getting care at Colorado hospitals through the program, with 212,000 patients as reported by 73 hospitals that turned data into the state.
The rate of charity care — financial assistance, free or discounted care, provided to people who can't afford to pay for it on their own — reported by hospitals keeps rising sharply. CHA estimated it’s up 60 percent in the past year and more than 150 percent since before the COVID-19 pandemic
The group said this is due to a rise in the number of patients applying for and getting coverage through the HDC program, plus hundreds of thousands of Coloradans who find themselves without coverage because they get kicked off Medicaid. “That to us is the measure that this is working,” Lonbong said.
One patient’s perspective
“It's like they really do make it as hard as possible,” said Kristanna Hall, a 31-year-old mother and former resident of Broomfield. Hospitals offer discounted care “because they legally have to and they make it as difficult and time-consuming and frustrating as possible.”
In 2023, her son Niklaus was born prematurely at 34 weeks, after a high-risk pregnancy. He caught COVID-19 and was isolated in a hospital NICU, neonatal intensive care unit. He had a slew of problems, including respiratory distress.
“We had close to a million dollars billed to our insurance last year. And I'm not exaggerating that figure. Just the 34-day stay for his NICU time was over $300,000 for that portion. So needless to say, medical costs can be extremely high, especially for small families,” said Hall, who recently moved to Texas.
While pregnant with her son, she’d been laid off from her job in the mortgage industry.
All told she had multiple hospital admissions and a C-section, plus the NICU stay and follow-up appointments. The health care they received took them to three hospitals, several specialists and also required an ambulance ride.
Hall said she qualified for discounted care, but then had a hard time with the applications. Each facility seemed to have a different way of handling it.
“One person would want to have you call by appointment only, the other person would want you to come in person,” Hall said. “The other one, you went through a phone tree of a hundred people and then maybe we're lucky to try and get a call back. There was not one similar thing across the board that made it simple or easy.”
Hall said she was able to negotiate and get her out-of-pocket costs down to $7,000 for last year, but it took what seemed like endless phone calls and emails.
“It's taken a lot of hard work to even get to that point,” Hall said. “It's just this daunting, huge experience.”
