Part 4: Health care top-notch, but price is enormous

Published: Wednesday, Oct. 21 2009 12:00 a.m. MDT

"It's an impossible Catch-22 of our day, but anyone can fall into it," said Dr. Paul Winterton, a Salt Lake orthopedic surgeon who hopes the current reform effort will reverse what he considers health care's "often oppressive" bill-collecting practices. "Until we start addressing the financial devastation being created by bankrupting people over medical care costs, we shouldn't get too carried away with how well we're controlling health care costs," he said.

The Jorgensons and other patients interviewed for this story say the financial scars can last beyond traumatic injuries and will continue to prevent them from being full participants in the economy because of the credit black mark next to their name.

Particularly threatening in tone are demand letters from care through the University of Utah hospitals and clinics. Those letters don't come from private attorneys but from the Utah Attorney General's Office, the state's top law-enforcement agency.

A form letter to delinquent payers begins by noting that University Health Care, "a governmental entity of the State of Utah," has referred "a debt" to the attorney general's office for review and possible collection.

The first paragraph threatens a lawsuit twice, filed either by the attorney general's office or by an "independent collection agency." It states that the bill might be outsourced to balance the account. The recipient is advised that his Social Security number is being sent to the Utah State Tax Commission and inserted into the state's Finders Program, which legally allows a lien to be placed on tax refunds for unpaid debts and in effect will garnish them for eight years or until the debt to the U. is paid in full.

And, to bring the point home that the debtor can't get out from under the debt, U. Health Care will keep the Finders Program advised on all delinquent hospital accounts in effect, "regardless of any payment agreements that may exist between you and University Health Care."

A patient who received a notice of a debt of $67 nine months ago received another last week saying that the debt is now $1,407 and has a judgment requiring payment.

Speaking only on condition of anonymity — "because this is embarrassing and I'm scared what might happen if I say anything" — the recipient said the debt was incurred, that a repayment plan was worked out, but additional finance charges have been added. "That combined with being out of work has made it impossible to get out from under this."

The letter from the AG's office is a kind of last resort effort to obtain payment, said Chris Nelson, spokesman for the University of Utah Healthcare System. Two other letters reminding them of the bill and a telephone call precede the notice from the AG's office, Nelson said.

"We work very hard to work things out before it gets to that point," Nelson said. "We have people who owe millions of dollars and they're paying $15 a month. I'm not saying that we can do that for everyone, but we try to do what we can to avoid having things get to that point."

University Health Care averages about $25 million in charity care and another $25 million to $30 million in bad-debt writeoffs, he said.

Most of the people on the edge of bankruptcy have been pushed to that cliff here and across the country by medical bills, said attorney Rogena Jan Atkinson. Even when people are insured, it is often capped by a lifetime limit, or the time off of work and loss of income can make their debt situation go from bad to worse.

Ted Meeker has a whopper of a bill — $289,000. That's as much as a new Ferrari 458 Italia, complete aromatic leather, carbon-fiber cockpit and really cool navigation system.

Meeker, 78, knows about space-age metals: He's got $179,000 worth of titanium in his back that has kept him out of a wheelchair.

He helped design the Polaris ballistic missile that kept the Cold War cold and helped refine the concept of refirable rocket motors that allowed man to go the moon.

His trajectory these days has a flatter arc, but the physics of getting up and around and dealing with the gravity of living with a bad back have been no less daunting.

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