CoxHealth Responses to News-Leader inquiries

March 18, Michelle Leroux, CoxHealth spokeswoman

We cant verify for you that what you are looking at is an apples-to-apples comparison between
CoxHealth and Mercy.
Because we are not privy to Mercys process, we can only speak to how we handle these cases.
In addition to the detailed information Ive provided you already, here are some additional
thoughts to consider:
CoxHealth is proud of the remarkable share of community benefit we provide to the citizens of
the region. To demonstrate our commitment we have included a comparison of certain statistics
from the last three 990s for CoxHealth Springfield and Mercy Springfield. Using a three year
average, the data from the 990s show;
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CoxHealth provided 28% more in financial assistance and community benefit dollars
than Mercy. As a percentage of total expenses CoxHealth provided 17% more financial
assistance and community benefit than Mercy.
CoxHealth incurred 55% more bad debt as a percentage of program service revenue than
Mercy. In a simple dollar measurement CoxHealth incurred 60% more in bad debt than
Mercy. Bad debt includes the amount of uncollected money that patients owe hospitals
for services after discounts and financial assistance is applied.
We believe our commitment to provide a high level of care access in some of the more
economically disadvantaged parts of the community through our Cox North hospital may
contribute to our significantly higher level of community benefit provided and bad debt
incurred.

CoxHealth deploys a robust financial assistance/charity care program. As a key part of the
program all uninsured patients, regardless of ability to pay, receive an automatic discount on
hospital services of more than 50%. After the automatic discount, all uninsured with income
below 300% of the poverty level are eligible to apply for additional financial assistance discounts
that can reach 100% depending on a persons income and ability to pay. It is important for our
patients to communicate with us. If they dont contact us or apply for financial assistance, we
arent aware of their financial struggles or if any changes have occurred in their financial
situation. All bills mailed to the patient provide a phone number to connect with a financial
advisor. We work with patients at any time. Even after a court judgment, we are open to helping
our patients determine the best way to meet their financial responsibility.
During 2014, CoxHealth encountered approximately 300,000 unique patients, many of them
multiple times. Our data shows the number of unique patient accounts that resulted in
garnishments is equivalent to approximately one patient out of every seventeen hundred (1/1,700
or .06%).

Were seeing more patients choose high deductible plans through their employer-provided plans
and marketplace insurance, which leave them responsible for a larger portion of their health care
bills and this is proving to be a catalyst for increasing bad debt activity. At higher levels of
responsibility these individuals can also apply for financial assistance to help cover the cost of
their out-of-pocket expenses.
I know Ive told you this already, but its extremely important. Our state lawmakers have not
approved Medicaid expansion. A restructured Medicaid program would create a bridge to health
care for the working poor and allow those without insurance access to primary care. Without
Medicaid expansion, many working poor continue to rely on the emergency department, where
cost of care is more expensive, as their source for primary care. Unintentionally, they take on a
burden of debt that many of them struggle to add to their budget. As a result we anticipate more
underinsured and uninsured individuals will seek financial assistance.
In your research, if you come across any patients who fall into this category and need assistance,
please have them contact us at 417-269-3117 or toll free at 1-800-711-9455. We often find
patients with financial difficulties do not engage with us, and we consequently cannot help them.
March 9, Michelle Leroux, CoxHealth spokeswoman
Reporter Q: Why does CoxHealth file these lawsuits?
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Patients have a responsibility to cover their out-of-pocket medical expenses after

insurance and financial assistance programs have been used. Ultimately, our number one
priority is to be available to provide excellent services of care to our patients. As a
locally governed non-profit hospital that is community centered, we are dependent on
revenue to continue to provide this elevated level and care and service to our patients.
We offer payment plans, financial assistance and discounts, but if patients do not
communicate with us their inability to pay their bill or need for a payment plan,
unfortunately people find themselves in the collection process which could include legal
action.
Patients are informed at bedside of potential financial assistance or called later if they are
an outpatient. Additionally, the availability of financial assistance is communicated at all
levels of care including in physician clinics, in our outpatient locations, on patient bills
and statements and verbally again when patients are contacted for payment.
We encourage patients who have medical bills to communicate with us, making use of
our payment plans or financial assistance programs so they can meet their payment
obligations. We work diligently with patients to prevent them from having their bills go
into a collections situation.

Reporter Q: Are there factors that explain why CoxHealth has more lawsuits on record than
Mercy?

We cant explain why you have found more CoxHealth mentions then Mercy. One thing
to consider is the number of uninsured patients seen at a facility. Caring for more
uninsured individuals essentially increases the changes of patients not being able to pay.

Reporter Q: Who is the typical person these lawsuits are filed against?
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The typical individual who faces the collections process is one who has not set up a
payment plan with our system and has not been in communication with our staff about
their current financial situation, and has been unresponsive to our inquires about their
medical bills. If a patient has been in communication with our staff and made efforts to
pay on their outstanding bills, we generally do not send them through the collections
process. The typical patient facing a collections action is of sufficient income, so he or
she is not qualified for a financial assistance program.
We work diligently with patients to prevent them from having their bills go into a
collections situation. When a patients financial responsibility has not been met, the
individual could be subject to collection activity, including legal action.

Reporter Q: What is CoxHealths current financial assistance/charity care policy?

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Our financial assistance program and applications are readily available to all patients
throughout our facilities and can also easily be found on www.coxhealth.com.
CoxHealth has a program to assure that financial assistance options are available to all
patients who are unable to pay for medically necessary services rendered at any
CoxHealth facility.
Financial assistance is available to any patient that meets eligibility guidelines.
Uninsured self-pay patients whose income falls between 0 to 300% of the federal poverty
level guidelines, which is up to three times the federal poverty level, may qualify, on a
case-by-case basis for financial assistance. That means a family of four can make up to
$71,000 and be considered for financial assistance for hospital fees.
Additionally, anyone whose bill exceeds an amount of $50,000 may qualify for a
financial assistance discount on their bill. The discount is determined on a case by case
basis.
It is expected that the patient pay for any remaining fees not covered by any discounts or
financial assistance. It is our intention to work with individuals on their out-of-pocket
responsibility.
On a case-by-case basis, underinsured patients may apply for financial assistance to
offset out-of-pocket expenses that remain following payments by their insurance
provider.

Take Away Key Points

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We dont want our patients to face the collection process.

We encourage our patients to utilize our financial assistance programs. If they dont
contact us or apply for financial assistance, we arent aware of their financial
struggles. Its important that patients call the number on their bill to discuss payment
options and help us help them through the financial assistance process.
Continued education is important on the proper use of our resources; treatment in an
emergency room where resources cost more versus treatment in a family medicine clinic
where resources are less expensive and typically result in lower bills for patients.
CoxHealth provided more than $53,803,473 in financial assistance, discounts and
CoxHealth Foundation patient grants in 2013.
It is very important that patients who have insurance understand their individual
insurance plans and the amount of out-of-pocket expenses for which they have
responsibility. We have advisors throughout our system that can help patients better
understand their insurance plans before or after their procedure to help those patients plan
financially and determine a payment plan that will allow them the flexibility to not
disrupt their everyday lives.
Our state lawmakers have not approved Medicaid expansion. A restructured Medicaid
program would create a bridge to health care for the working poor and allow those
without insurance access to primary care. Without Medicaid expansion, many working
poor continue to rely on the emergency department, where cost of care is more expensive,
as their source for primary care. Unintentionally, they take on a burden of debt that many
of them struggle to add to their budget. As a result we anticipate more underinsured and
uninsured individuals to seek financial assistance.

Mercy Springfield Communities Statements issued in responses to inquiries

March 11
As a part of our healing ministry, Mercy is committed to providing quality health care services to
patients regardless of their financial situation. Mercy strives to help our patients access
affordable health care through a variety of options, a few of which are described further below.
Our certified application counselors have been helping to enroll people in the federal health
insurance marketplace. Since 2013, approximately 30,000 patients with marketplace insurance
have received care at a Springfield area Mercy facility; about one third appear to have had no
prior insurance coverage.
Information regarding our charity care program is listed on patient statements as well as online.
Through the financial counseling process available at the time of service, Mercy can screen
patients to see if their economic status qualifies them for charity care. If patients qualify, all or a
portion of their bills are forgiven or discounted on a sliding scale in accordance with national
poverty guidelines. Assistance may be provided for patients who have an annual income up to
400 percent of the federal poverty guidelines. In the fiscal year ending June 30, 2014, Mercy
Springfield Communities provided more than $35.4 million for the cost of care to patients who
were unable to pay for all or part of their care.
Mercy recognizes that along with uninsured patients, we often serve those who are under-insured
and may not be able to afford to pay a bill in its entirety when it is due. We work with our
patients to set up affordable payment plans that keep their accounts in good standing. Mercys
traditional payment plans allow patients a year to pay off their balance with no interest. In
addition, the Extended Payment Plan option was instituted in November 2014 through a
partnership with a local lending institution. It allows patients to take out a no-interest loan to
cover their medical expenses. So far, 2,445 patients in the Springfield area have taken advantage
of this program.
March 27
IRS guidelines allow hospitals to report their bad debts at either gross billed charges or cost of
care. While a lower figure, Mercy has chosen to report its amount at the estimated cost of
providing the care because its a better representation of the actual cost of the unreimbursed care.
In addition to the charity care figure reported on Mercy Hospitals 990, Mercy Clinic in
Springfield and the surrounding communities also provides charity care, which totaled more than
$18 million last fiscal year.
Mercy Springfield Communities includes Mercy Hospital Springfield and regional hospitals in
Lebanon, Mountain View, Aurora and Cassville, Missouri as well as Berryville, Arkansas. Many
communities in this wide service area are economically disadvantaged. Our values call us to give
only the best to those entrusted to our care, with particular concern for those who are
economically poor. We work to treat our patients with dignity by providing them with a

comprehensive financial assistance policy and giving them options for paying their medical
bills.
Information regarding our charity care program is listed on patient statements as well as online.
Through the financial counseling process available at the time of service, Mercy can screen
patients to see if their economic status qualifies them for financial assistance. If patients qualify,
all or a portion of their bills are forgiven or discounted on a sliding scale in accordance with
national poverty guidelines. Assistance may be provided for hospital patients who have an
annual income up to 400 percent of the federal poverty guidelines. Patients who qualify for
charity care do not have their bills classified as bad debt.
In addition, Mercy works with our patients to set up affordable payment plans that keep their
accounts in good standing.