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Ghost Bill: UVA Siphons Couple’s Tax Refund To Pay 20-Year-Old Medical Debt

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The notice from the Virginia tax department puzzled a Charlottesville couple last October. It said their state income tax refund had been reduced because of an outstanding medical debt to the University of Virginia Medical Center. Instead of $220, they got $110.

Mystified, they contacted UVA for details about the unpaid bill. The answer astonished them. The medical center had asked the tax department to withhold the money for medical care their son received in 2001 and 2002.

Jane Collins and Anthony Blow received a notice last year from the Virginia tax department, which reduced their state income tax refund to offset outstanding medical debt.(Courtesy of Jane Collins)

“The amount is not the issue; it’s this whole idea that you can go after something that is so old,” said Jane Collins. “Maybe technically you are entitled to that money, but do you mean to tell me you can go into the deep recesses of your computer and now you’re going to take this?”

Initially, Collins couldn’t remember what the bill was for, and she no longer had paper records from nearly two decades ago.

According to financial documents the hospital sent Collins and her husband, Anthony Blow, late last year, the bills relate to three hospitalizations for their son, who was born prematurely and frequently hospitalized as a child.

Collins believes the 2001 hospital visits are probably related to a shunt her son had when he was 3 to relieve fluid buildup in his brain. She’s uncertain what the 2002 charges are for. The computer printouts she received from UVA list service codes and billed charges but don’t describe why he was hospitalized.

“I’m utterly confused by all of this,” said Collins, whose family is covered by the same employer plan they had then. “Eighteen years later, I don’t remember disputing anything about the bills.”

A spokesperson for the health system said patient privacy laws prohibit them from commenting on specific cases.

Virginia is one of at least a dozen states that can dock residents’ income tax refunds to pay delinquent medical debts, according to Richard Gundling, a senior vice president for the Healthcare Financial Management Association, an organization for finance professionals. In Virginia, state-affiliated hospitals like the University of Virginia Medical System and Virginia Commonwealth University Health System generally first attempt to collect money owed to them directly or by enlisting a collection agency.

If those efforts fail, they send the claims to the state tax department’s Set-Off Debt Collection Program. The tax department uses Social Security numbers to electronically match claims submitted by the hospitals with individual income tax refunds. When the system finds a match, it withholds all or part of the refund and sends it to the hospital.

In fiscal 2018, Virginia collected $68 million in individual debts through the program, a figure that includes medical bills and other types of debt owed to state and local government agencies and state courts, among others.

It’s a controversial way to collect medical debt, especially for care delivered decades ago.

“This gives a whole new meaning to surprise medical bills,” said Mark Rukavina, business development manager at Community Catalyst, a consumer advocacy organization. “Digging up a bill that’s 20 years old and informing someone that they owe it by attaching their tax refund is not good policy.”

State laws prohibit private collection agencies from suing consumers after a specified period of time, often three to six years. The laws don’t extinguish the debt, but they protect consumers from being taken to court many years later, when documents may be lost and memories fuzzy.

But there’s no similar time limit for going after Virginia consumers’ tax refunds through the setoff program.

“[This] hospital is an agency of the commonwealth and the statute of limitations doesn’t apply to the commonwealth,” said Caroline Klosko, an attorney at the Legal Aid Justice Center in Charlottesville. Klosko said she worked with a client who faced a similar refund capture by UVA for a medical debt that was six years old.

In addition to the age of the debt, concerns over whether the amount billed is accurate are often legitimate.

What if people are charged too much in the first place? Federal law requires nonprofit hospitals to have patient financial assistance policies and to publicize them widely. For-profit hospitals generally seem to have similar programs, said Rukavina. But income standards and other requirements to qualify for discounted or free care vary widely and may not be easy for patients to find.

A new state law will prohibit UVA and VCU from taking consumers’ tax refunds to satisfy medical debts unless the health systems have determined that patients aren’t eligible for their financial assistance programs or Medicaid, the state-federal health insurance program for low-income people.

UVA screens people routinely for financial assistance and Medicaid eligibility, according to spokesperson Eric Swensen. Every year, the health system helps roughly 3,500 people qualify for Medicaid or Family Access to Medical Insurance Security, a program for children whose families earn too much for regular Medicaid, he said.

If someone has an overdue bill with UVA, the health system turns to the refund setoff program as a last resort after all other options, including establishing interest-free payment plans, have been exhausted, Swensen said. In 2019, UVA received $4 million from tax refunds for delinquent medical debt, according to Swensen. Virginia Commonwealth University Medical Center collected approximately $7.7 million through the debt setoff program in 2019, according to spokesperson Laura Rossacher.

Collins said that she and her husband knew nothing about their debt until they got their smaller-than-expected “tax relief refund” last fall, along with a notice directing them to contact UVA if they had questions. (Under a 2019 state law, Virginia taxpayers were eligible to receive a one-time tax relief refund of up to $110 for individuals and $220 for married couples who file their taxes jointly.)

She said the couple had received state tax refunds in the years since this care was provided.

Swensen said that, in general, once a patient’s outstanding balance is sent to the state’s setoff program, “we are required to resubmit that balance to the state database each year until the patient pays their outstanding balance or the outstanding balance is satisfied through the debt setoff program.”

“If a patient had previous tax refunds that were not assessed, we are unsure why this happened,” he said.

A patient financial services representative at UVA told Collins the health system had sent billing statements, as well as final notices informing the couple that their accounts were being referred to collections. UVA also said it had notified them that the accounts would be reported to the state Department of Taxation.

Collins said that they never received those notices but that after their tax refund was withheld, they did receive several notices.

In October and November, Collins and Blow received letters from both UVA and the tax department informing them of four setoff claims totaling $220, in the amounts of $67.39, $42.61, $78.63 and $31.37. Two of the dollar amounts matched up with the itemized bills from UVA, but two did not. If they wanted to contest the claims, the notices said, they could request a hearing with UVA. Collins did so.

Subsequently, the UVA patient services rep said that as a “one-time courtesy” the health system would release the hold on the $110 from their refund, Collins recounted.

In late May, Collins and Blow received a “patient refund card” worth $31.37 from UVA for their son’s care. But the odyssey continues. The following week, the state tax department informed them it had once again withheld money from their tax refund — $5.79 this time — to satisfy an unpaid UVA debt.

Collins said she planned to call UVA to ask about the refund offset, but she assumes it’s also related to her son’s care nearly 20 years ago.

How much longer will this go on, Collins wonders. Do Collins and Blow still owe money to UVA? If they do owe money, how much do they owe? And why did it take so long for UVA to come looking for it?

Collins said she has asked UVA those questions but hasn’t gotten clear answers. Her frustration is through the roof.

“You know what I think government agencies and state hospitals are good at?” Collins asked. “Obfuscation.”

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By: Michelle Andrews
Title: Ghost Bill: UVA Siphons Couple’s Tax Refund To Pay 20-Year-Old Medical Debt
Sourced From: khn.org/news/ghost-bill-uva-siphons-couples-tax-refund-to-pay-20-year-old-medical-debt/
Published Date: Wed, 24 Jun 2020 09:00:14 +0000

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At Least 1.7M Americans Use Health Sharing Arrangements, Despite Lack of Protections

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A new report has provided the first national count of Americans who rely on health care sharing plans — arrangements through which people agree to pay one another’s medical bills — and the number is higher than previously realized.

The report from the Colorado Division of Insurance found that more than 1.7 million Americans rely on sharing plans and that many of the plans require members to ask for charity care before submitting their bills.

The total membership numbers are likely even higher. The state agency collected data from 16 sharing plans across the U.S. but identified five other plans that did not report their data.

“These plans cover more people than we had previously known,” said JoAnn Volk, co-director of the Center on Health Insurance Reforms at Georgetown University.

Under the arrangements, members, who usually share some religious beliefs, agree to send money each month to cover other members’ health care bills. At least 11 of the sharing plans that reported data operated in or advertised plans in all 50 states in 2021.

Sharing plans do not guarantee payment for health services and are not held to the same standards and consumer protections as health insurance plans. Sharing plans are not required to cover preexisting conditions or provide the minimum health benefits mandated by the Affordable Care Act. And unlike health insurance, sharing plans can place annual or lifetime caps on payments. A single catastrophic health event can easily exceed a sharing plan’s limits.

In Colorado, at least 67,000 people were members of sharing plans in 2021, representing about 1 in 4 Coloradans purchasing health care coverage on their own. That rate concerns Kate Harris, a chief deputy commissioner of the Colorado Division of Insurance, which she said regularly receives complaints from sharing plan enrollees.

“What we hear from consumers is that when they purchase one of these, they do think there is some guarantee of coverage, for the most part, despite the disclaimers on many of the organizations’ websites,” Harris said.

The Colorado report found that health sharing arrangements often require their members to seek charity care or assistance from providers, governments, or consumer support organizations before submitting sharing requests. Those costs are then shifted to other public or private health plans.

Katy Talento, executive director of the Alliance of Health Care Sharing Ministries, which represents five of the largest and longest-operating sharing plans in the country, said sharing ministries encourage members to act like the uninsured people they are. Such requirements to seek charity care reflect a desire to be good stewards of their members’ money, Talento said.

“Think about it like a soup kitchen,” she said.

Fourteen sharing plans reported that Colorado members submitted a cumulative $362 million in health bills in 2021, and nearly $132 million of those requests were approved. The remainder, sharing plan executives told the division, reflected duplicative bills, ineligible charges, negotiated discounts, and the members’ agreed-upon portion of medical bills.

“It’s not like every claim line on a health care sharing request is going to be eligible for sharing,” Talento said. “They have to submit the whole bill. They can’t just pull out a piece of it.”

But consumer complaints to the Division of Insurance and to consumer assistance programs, such as the Colorado Consumer Health Initiative, show that members do not always realize what sharing plans will cover.

“We have seen firsthand the risks that people face when they sign up for these arrangements without recognizing the magnitude of the risk that they’re assuming for their health care costs,” said Isabel Cruz, the initiative’s policy director.

Talento disputed the notion that members don’t know the parameters of their sharing plans.

“That’s just suggesting that our members are dumb,” she said. “Is it likely that somehow our people are going to be willy-nilly jumping blindly into something?”

Theresa Brilli, a small-business owner in Longmont, Colorado, said she and her partner signed up for a direct primary care plan in 2017 that covered primary care visits for $179 a month. Direct primary care plans are payment arrangements between patients and providers for receiving health services without billing insurance. The plan had an arrangement with Liberty HealthShare, a Canton, Ohio-based sharing plan with more than 131,000 members nationwide, to cover additional services like preventive screenings, emergency room care, and hospitalizations for $349 a month with a $1,000 deductible. The rates increased to $499 a month, with a $1,750 deductible, in 2020, Brilli said.

But Brilli said getting payments was a major hassle.

“It took about four to eight months to get reimbursed,” she said. “It was a fight, every bill.”

When she heard about enhanced subsidies for ACA marketplace plans in 2022, she decided the hassle was no longer worth it and switched to a Kaiser Permanente plan for $397 a month.

“I will never go back to Liberty Health or a health care sharing plan,” she said. “I didn’t agree with the whole ministry thing. They made you sign off saying you believed in God, which was like, ‘Whoa, I guess that’s what I have to do to get my health insurance.’”

Laura Murray, 49, of Aurora, Colorado, said she signed up for a Liberty HealthShare plan in 2017 as a more affordable alternative to her husband’s employer-based plan.

“We kind of felt we were cutting out the middleman in a way, and it was a helping-out-your-neighbor sort of deal,” she said.

But when she became pregnant unexpectedly, she had trouble getting her health bills paid. Initially, Liberty paid only a portion of the tab, and her bills got sent to a collection agency. It was only through multiple calls that she learned she needed to send the bills to a third party that would negotiate with the providers.

“It took years to get it cleared up,” she said.

Timothy Bryan, Liberty’s vice president of marketing and communication, disputed many of the details of Brilli’s account and attributed some of the delay in payment to her “failure to submit the required supporting documentation.” Murray’s payments, he said, were delayed more than 10 months because she had failed to provide the required pre-notification.

Mike Quinlan, 42, of Denver, turned to a health sharing ministry in 2014 after the birth of his first child cost him more than $17,000 out-of-pocket, on top of nearly $24,000 in premiums that year, under an employer-sponsored health plan. He said the births of his three youngest children were covered in full by Samaritan Ministries International, a Peoria, Illinois-based sharing plan with 359,000 members, to which he contributes $600 a month. When he incurs large health expenses, he receives a slew of $600 checks from other members, he said.

Every year, Quinlan attests that he is a Christian and identifies the church he attends.

“This is a group of like-minded people who have said voluntarily we’re going to trust each other to cover each other’s health costs,” he said.

The rules differ from plan to plan. Some sharing plans require members to pledge to abide by Christian principles, and some exclude payment for out-of-wedlock births or health issues that arise from drug use. Many sharing plans exclude coverage of contraception, mental health services, and abortion, often with no exceptions for rape or safety of the mother.

Regulators in Colorado and other states have also expressed concerns that health sharing arrangements are paying brokers much higher commissions for signing up members than health plans do. That could create financial incentives to push sharing plans over health insurance without adequately educating consumers about the differences.

In 2019, Covered California, the Golden State’s ACA marketplace, instituted a requirement that its certified agents who sell both sharing plans and health insurance provide consumers with a list of disclosures about sharing plans and show them the subsidies they could receive for buying traditional health insurance coverage.

“It’s really important that consumers understand what these arrangements are, and what they are not,” said Jessica Altman, executive director of Covered California.

Harris said the Colorado Division of Insurance is investigating multiple health sharing arrangements based on consumer complaints but declined to name them.

Colorado officials are also concerned that health sharing arrangements might appeal primarily to people who don’t expect to use many health services. That could increase the proportion of sicker and more expensive patients among enrollees in traditional health insurance plans, driving up premiums.

Harris said many consumers can get a health plan for less than the cost of a sharing plan, particularly with increased federal and state subsidies put in place in recent years. State officials are also working to inform consumers of the financial risks associated with health sharing arrangements, some of which have gone bankrupt in recent years.

“It might look cheaper on its face, month to month,” Harris said. “But if they do really actually need their costs covered, there’s a real risk that they may not be.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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By: Markian Hawryluk
Title: At Least 1.7M Americans Use Health Sharing Arrangements, Despite Lack of Protections
Sourced From: kffhealthnews.org/news/article/health-sharing-arrangements-ministries-protections-risks/
Published Date: Wed, 14 Jun 2023 09:00:00 +0000

 

 

 

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Retirement Planning

Give Yourself the Perfect Retirement Gift

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Give Yourself the Perfect Retirement Gift

From day one, everyone looks forward to retirement, that day where they can finally let go of the stresses of the daily grind and spend their leisurely days traveling, reading and basically having fun. As compared to previous generations, we have longer life spans so we all expect our golden years to be fulfilling and rewarding.

Instead of waiting for people to help you plan your retirement, you should do it yourself. Although retirement planning is probably one of the most draining activities where one spends loads of time perusing over financial and brokerage statements, benefits brochures and insurance policies. One does this in terms of the benefits of long term planning: if one retires earlier, he/she will think and anticipate less on government-funded plans which only gives a pittance of a pension and focus more on the beauty of life.

Why Retirement Planning is Necessary

Obviously, retirement planning isn’t all about numerous hours of stress by chugging down numbers and analyzing mutual funds: it’s about fixing and deciding how you will live the final years of your life. If one can balance financially and plan fully on a retirement plan, rest assured that your future is secure.

But remember that retirement planning isn’t a singular activity. It is something that stretches forth to decades, spanning your 30s, 40s and 50s. In every decade, one must rethink their strategies since you are inching closer and closer to retirement, thus one must forgo risky investments and go to bonds and reliable mutual funds as the years pass by.

Build the Right Retirement Plan

A retirement plan must be suited to your risk tolerance and apparent need for cash when retirement comes. If you prefer a general 401(k) that has a good balance of everything, you may go for equal amounts of low-risk bonds and riskier stocks or you may also opt for an assortment of mutual funds that both have high-risk and low-risk funds.

Generally, risk tolerance is congruent to one’s age. If you are on your 20s or early 30s, you may opt for a more stock-saturated mutual fund in the hope of getting a good return because of the added risk stocks give. If ever the worst comes and you face some declines in the stock market, you still have a good 20 to 30 years to compensate for the losses.

On the other hand, if one is teetering on the 40s or 50s, it is necessary that one must go low-risk in his/her investments. One’s mutual funds must now be concentrated more on low-risk government bonds, which virtually assure no losses and minimum gain, if there will be no huge political crisis, of course.

If one follows this general age/risk rule, then one has better chance that one has an ample amount of cash to spend on the pleasures of life when retirement age finally comes.

Conclusion

One has always dreamt of traveling the world, playing golf all day and enjoying the best life can give. But one cannot do all that while working away in the office. Therefore one must give importance to the rising necessity of building a retirement plan.

It is probably as stressful as work itself, but if you can carry all that heap of information and mix it into the delicacy that is a finely tailored retirement plan, then rest assured that your dream of tasting and relishing the best of life is definitely reachable by 65.

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Retirement Planning

Ends-of-the-World Every Year Since 1970

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There always has been and always will be a reason not to invest or not to stay invested. This is all the mainstream media reports to us. Below you will find a list of some of the worst global events each year since 1970. I have some commentary to follow.

1970: War: US troops invade Cambodia.
1971: Civil Unrest: Anti-war militants march on Washington.
1972: Political: Start of Watergate Scandal.
1973: Economic: OPEC raises oil prices in response to US involvement abroad.
1974: Political: Nixon resigns as President of the United States.
1975: Political: Multiple assassination attempts on President Ford.
1976: World: Ebola virus.
1977: Political: Government shutdowns.
1978: Market: U.S. Dollar plunges to record low against many European currencies.
1979: World: Iranian militants seize the U.S. embassy in Teheran and hold hostages.
1980: Economic: Inflation spiked to a high of 14.76%.
1981: Political: President Reagan assassination attempt.
1982: Economic: Recession continues in the U.S. with nationwide unemployment of 10.8%.
1983: Economic: Unemployment in the U.S. reaches 12 million.
1984: Economic: 70 U.S. banks fail during the year.
1985: World: Multiple airplane hijackings around the world.
1986: World: Chernobyl Nuclear Power Station explodes.
1987: Market: DOW drops by 22.6% on October 22.
1988: Environment: Awareness of global warming and the greenhouse effect grows.
1989: Environment: Exxon Valdez dumps 11 million gallons of crude oil into Prince William Sound.
1990: World: Persian Gulf War starts.
1991: World: Mass shooting in Killeen, TX.
1992: Human Rights: Los Angeles riots following the death of Rodney King.
1993: Terrorism: World Trade Center bombing.
1994: World: Mass genocide in Rwanda.
1995: Terrorism: Oklahoma City bombing.
1996: Terrorism: Olympic Park bombing.
1997: World: Bird flu.
1998: World: Multiple U.S. embassy bombings.
1999: World: Columbine shooting.
2000: Economic: Start of the Dotcom Market Crash.
2001: Terrorism: Terrorist Attacks in NYC, DC & PA.
2002: Economic: Nasdaq bottomed after a 76.81% drop.
2003: World: The U.S. invades Iraq.
2004: World: The U.S. launches an attack on Falluja.
2005: World: Hurricane Katrina
2006: World: Bird flu.
2007: Economic: Start of the Great Recession.
2008: Economic: Great Recession continues.
2009: Economic: S&P bottomed after a 56.8% drop.
2010: Market: Flash crash.
2011: Market: Occupy Wall Street and S&P downgrades U.S. Debt.
2012: Political: Fiscal cliff.
2013: Political: Taper tantrum.
2014: World: Ebola virus.
2015: World: Multiple mass shootings.
2016: Political: Divided U.S. Presidential election.
2017: World: North Korea testing nuclear weapons.
2018: Economic: U.S. & China trade war.
2019: Economic: Student loan debt reaches an all-time high of $1.4 trillion.
2020: World: COVID-19.

While many of these events were undoubtedly terrible (and there are certainly others not named here that were worse), most of these were broadcast as end-of-the-world events for the stock market. Despite that attention, it is worth noting that these were, for the most part, one-time events. In other words, most faded into the newspapers of history. We moved on.

Obviously, some caused monumental shifts in the way the world works. Just think about how much air travel continues to be impacted by the events of 9/11. But, outside of the resulting inconveniences (if we want to call safety protocols inconveniences) associated with air travel, flying is safer than ever before.

Take a look at just about any of the events and you will find there are many that people will hardly remember. My point here isn’t that these events are to be ignored or that they were easy to stomach at the time, but that they have become a distant memory.

I want to also make the point that we should expect these types of negative events. As investors, we know these types of crises, economic catastrophes, and global phenomena are going to happen.

But in almost all cases, here is what we can say in the next breath – this too shall pass.

Will there be legal, humanitarian, economic, or some other aid required as a result of these events? Almost certainly the answer is yes, but that doesn’t mean it they won’t eventually fade into history.

Lastly, what’s worth noting is how the market has performed over these last 50 years despite the continual advertisements of the world crashing down around us. On January 2, 1970, the Dow Jones stood at 809 and the S&P at 90 -> those are not typos. These same indexes have grown (not including dividends) to 26,387 and 3,232 respectively. Amazing, no?

Perhaps what gets overlooked more than anything else is what separates the above one-time negative events from the positive stories that go largely ignored over our lifetimes. And that is a story worth telling. See the companion post below:

Unheralded Positive Events Every Year Since 1970

Stay the Course,
Ashby


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The post Ends-of-the-World Every Year Since 1970 appeared first on Retirement Field Guide.

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By: Ashby Daniels, CFP®
Title: Ends-of-the-World Every Year Since 1970
Sourced From: retirementfieldguide.com/ends-of-the-world-every-year-since-1970/?utm_source=rss&utm_medium=rss&utm_campaign=ends-of-the-world-every-year-since-1970
Published Date: Tue, 04 Aug 2020 13:26:19 +0000

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