The ANNOTICO Report

This will be a cruel familiar story if a member of your family has had a
serious medical problem.
Or this may be something that you have to look forward to.

Keep in mind that in Ethnic communities that are "organized", they can
often bring pressure on out of line Medical Organizations to be more
reasonable, as a matter of fact on ANY serious problem.

But the community HAS to be Organized, and YOU must be apart of it. You
can't expect to avoid the responsibilities, and then when you have a
problem expect the community to "fix it".

Bergen Record and Herald, NJ
By Lindy Washburn
Staff Writer
Sunday, June 12, 2005

The sheriff's constable delivered the lawsuit to the neat brick home in
Cliffside Park on Valentine's Day. It was a bouquet of heartache from
Hackensack University Medical Center.

"GUIDO OSSO," it read. "You are hereby summoned in a Civil Action of the
Superior Court of New Jersey."

The reason: Failure to pay a hospital bill of $160,170.35.

The wanted man sat at home, slumped in his wheelchair. His head rested on a
television tray and his bottom on an incontinence pad. Since a devastating
series of strokes in 1999, the 66-year-old Osso hadn't known what day it
was, much less the details of his worsening financial situation.

He'd been a butcher all his working life, cutting steaks and roasts at the
Grand Union and A&P. He was a member of his union's health plan. When he
felt sick that October morning as he woke up to take his 14-year-old son to
school, his family thought only of his health.

Little did they know that his illness could end up costing them everything.

Guido Osso didn't have enough health coverage. It ran out 21 days into his
38-day stay at Hackensack.

>From that moment on, everything done for Guido was on Guido's dime.

He was charged the hospital's highest rates - its so-called sticker prices
- rather than the heavily discounted fees insurers pay. That meant he was
billed nearly twice as much as his health plan would have paid for the same
care.

And when he no longer qualified for the insurance discount, the hospital
was no longer satisfied with his plan's payment for those first 21 days. He
was billed tens of thousands of dollars more for that care, too.

It was all completely legal. The Osso family's predicament was business as
usual for the hospital's billing department.

"We look to recover our charges one way or another," said Harold Hogstrom,
Hackensack's chief financial officer. If a patient is underinsured, "we
can't be expected to write the rest of it off."

Guido Osso's story is a cautionary tale. It shows how inadequate insurance,
rising medical costs and aggressive hospital collections all contribute to
America's worsening health-care crisis. For millions of Americans,
financial disaster is just one hospital stay away.

Across the nation, a growing number of Americans have less coverage than
they need. Many have less than they think they have. As insurance costs
soar, employers are trimming benefits, raising deductibles and sometimes
dropping health coverage altogether. The result: Medical bills now cause
nearly half of all bankruptcies, according to a recent study - and most of
the victims are middle class and insured at the time of their illness.

Elia Osso, Guido's wife, feared her family would become one of those
statistics. Every flat surface of her home was covered with medical bills,
every day filled with worry.

For five years before the lawsuit arrived, Elia had cared for her husband -
fed, bathed and shaved him, brushed his teeth, cooked his food, pivoted him
from bed to wheelchair and wheelchair to bed. No holidays, no respite and
no thanks from Guido, whose mind is elsewhere, permanently.

She was at once fiercely protective - and powerless.

"They call my Guido a criminal?" Elia asked, furious and frightened, a few
days after the papers arrived. "They want to put me in jail?" She switched
to Italian, a torrent of words her daughter partially translated as, "They
are cold, heartless hypocrites."

"I am in jail already," she said, finally, her chest heaving.

A CRUSHING BURDEN

Elia Osso went to school in Italy, but only through fifth grade. She could
barely read the lawsuit, much less understand it.

She was overweight, overworked and overwrought. Her brown eyes overflowed
with tears. Until she broke her elbow in March and Guido was moved
temporarily to a nursing home, her nights were interrupted whenever her
husband called for water or needed help to the bathroom.

At 53, she felt like an old woman.

Before Guido got sick, the Ossos were living the immigrant dream. They
worked hard to pay off their mortgage and put two of their three children
through college.

But Elia had to quit her factory job to care for her husband, and now she
and her son are without health insurance. She drew down their savings to
buy Guido's medicines and adapt their house for his wheelchair. For a
while, she tried to keep the collection agency at bay with $100 a month,
she said.

Last December, her two daughters, Sabrina and Susan, met with Hackensack's
patient accounts department to offer as much as they could - everything
except the house. Their offer totaled $32,000, they said.

The hospital said no. Nothing less than $80,000 would do. "He has assets,"
said Anne Goodwill Pritchett, vice president of patient accounts.

Now, Hackensack University Medical Center - the hospital whose charity
galas have raised $1.3 million in a single star-studded evening - was
taking the Ossos to court. Elia feared they would take her home.

"My parents don't have some Swiss bank account," said Sabrina, a computer
support analyst. "They never lived luxuriously. It was just basic stuff.
... What will we do for my mother if we have to sell the house? That is the
last, last, last thing they own."

THE COVERAGE RUNS OUT

Guido Osso's story began in Calabria, Italy. He emigrated in 1949 as a boy
of 11. His father found work as an ice man in New York City, and Guido went
to school. He eventually enrolled at Hunter College, but quit to work.

He was a serious man. He worked as many hours as he could get - nights,
weekends, holidays - to support his family.

In 1972, he bought the house in Cliffside Park. With a rental apartment on
the first floor, and room for a growing family in a spacious upstairs
apartment, it was a solid investment. It's now assessed at $338,000.

Like most Americans with a job, Guido didn't have much choice when it came
to his health coverage. It was simple: take what was offered.

He was a member of Local 464A of the Food and Commercial Workers
International Union, which counts more than 18,000 food-industry employees
in New Jersey and New York.

The union is proud of its benefits. The plan includes "doctor and hospital
visits, major medical coverage, medical center services," according to its
Web site. The coverage comes with union membership and there is no
deductible. A health center at the union's headquarters in Little Falls
provides free medical care for members.

"In this day, you'd be hard-pressed to find a plan as generous," said
George R. Murphy, an attorney for the local's welfare funds.

But, as the Ossos would discover, Local 464A's Health and Welfare Plan had
serious shortcomings.

The plan limited its coverage to 31 days of hospital care per illness each
year, plus $100,000 more over the course of Guido's lifetime for additional
hospital days or other medical expenses.

The Ossos would soon learn that a major illness can quickly eat through
that kind of coverage. Guido was in the hospital for 48 days: 38 at
Hackensack and 10 before that at Palisades General Hospital in North Bergen.

His health plan also failed to cap the amount Guido would be required to
pay for medical care. Most insurance plans set maximum out-of-pocket
expenses, after which the insurer pays everything. But Local 464A's plan
simply stopped when its limit was reached, leaving Guido liable for
everything that followed.

"That's almost like no insurance," Hogstrom, the Hackensack CFO, said of
Guido's health plan. Most plans cover at least six to 10 months in the
hospital, he said.

Murphy defended the union's benefits as "outstanding," especially compared
with what he called the meager benefits provided by many in the grocery
industry. When 45 million Americans have no health insurance at all, to
disparage the plan would be "truly outrageous," the Washington-based
attorney wrote The Record.

Despite written permission and a request from the Osso family, Local 464A's
officers - John T. Niccollai, its president, and Kathleen F. Pridmore, its
director of medical benefits - declined to speak about Guido Osso's case.

"We just have a policy not to put our business on the street," Murphy said.

But a state labor leader expressed sympathy for Guido. "I've got a heavy
heart, because he's a union man," said Charles Wowkanech, president of the
New Jersey State AFL-CIO, which includes Local 464A. "But we're all in the
same boat."

Unions are caught in a vise when it comes to benefits these days, he said.
The costs of health benefits in New Jersey are among the highest in the
nation.

"When you're competing against the likes of Wal-Mart, which is paying $6 or
$7 an hour, exploiting immigrants and offering no health-care plan, the
good players are being forced to come down to a level like this," Wowkanech
said.

Most people are like the Ossos - they don't know until it's too late where
the holes in their coverage are. Elia had never read the booklet describing
the union health plan, and her husband probably had just glanced through
it, she said.

Elia didn't think about costs when she had her husband transferred to
Hackensack from Palisades General Hospital. The ambulance had taken Guido
to the closest hospital, but after 10 days he was getting worse. Elia
thought he would do better at Hackensack.

"I trusted them," she said.

Hackensack is a top-ranked institution whose size and reputation have grown
the past 15 years. From childbirth to heart surgery, stem-cell transplants
to trauma care, the hospital has a distinguished record. It is full or
nearly so on most days, when many hospitals around the state are half-empty
and losing money.

When Guido was admitted, the hospital asked him to sign paperwork accepting
responsibility for any unpaid bills. But nobody told him that from Day 22
on, it was all coming out of his pocket.

There he lay in his room on the fourth floor, swallowing his pills and
drinking his Ensure, with machines monitoring his heart rate and oxygen
level, as his bill climbed by thousands of dollars a day.

115 PAGES OF TROUBLE

The meter just kept running.

Each day, Guido was charged the full sticker price - $3,348 - for room
rent.

And like an a la carte restaurant menu, every service he received resulted
in an additional charge.

The oxygen flowing through a tube in his nose: $541 a day.

The device that measured his blood-oxygen level: $286 daily.

Feeding bags: $31 for a day's supply.

The 8-ounce cans of nutritional drinks he was fed instead of solid food
were a dollar each. The speech therapist who assessed his hearing and
stroke-addled speech added $170 each time she visited. The professional who
spent 30 minutes walking with him in the hallway: $62 more.

Guido's bill for his 38-day stay in late 1999 stretches to 115 pages.

It is full of unexplained corrections, long numeric codes and arcane
abbreviations. The list of charges for a single day includes 67 items.

An analysis of the bills - with assistance from a pharmacist and the Health
Care Payers Coalition of New Jersey, a non-profit alliance of business,
union and trade-association benefit plans - revealed that:
 

Guido was charged 2¼ to 10 times what Medicare would have paid for services
ranging from chest X-rays to the telemetry that monitored his heart rate.
The federal government sets Medicare rates to reflect actual average
hospital costs, and they are used as a benchmark by insurance companies
when setting their own payments.
 

He was charged two to seven times the average wholesale price for
medication. A simple aspirin, which costs a hospital less than a penny, was
14 cents. A drug for the treatment of anemia was marked up 500 percent, to
$606 per dose.

The total charges were $232,689.83.

Had Guido been discharged on his 21st day, when his health plan was still
covering his care, the hospital would have accepted the plan's check for
$46,865 as payment in full. Even for the 17 additional days of his stay,
Guido would have owed only $50,000 had he been allowed the same discounts
as his health plan.

But it didn't work that way. The insurer's discount applies only if the
insurer pays for the entire stay, Hogstrom said.

When the hospital took away the discount, it billed Guido Osso "sticker
price" for each and every item of his entire stay - it even expected him to
pay tens of thousands more out of his own pocket for care his plan already
paid for.

His final bill - minus his plan's payment, an "adjustment" of $41,676.86,
and $70 for his telephone - totaled $144,077.97.

In early 2000, the sick man went back to the hospital. His stays at
Palisades General, Hackensack, and the Kessler Institute for Rehabilitation
exhausted the $100,000 lifetime maximum his health plan provided for
additional medical costs, according to a letter from the plan's director of
medical benefits. When he finally left Hackensack the second time, he had
racked up a bill for $16,192.38.

That's how Guido Osso came to owe $160,270.35 to Hackensack University
Medical Center. The hospital's lawsuit inexplicably subtracted $100 from
the bill, but demanded attorney's fees and interest.

Hospital officials said the size of Guido's bill is unusually high because
his plan covered so little of his stay. But there was nothing unusual in
the way it was calculated.

"Patients are responsible for whatever their insurance company doesn't
pay," Hogstrom said. "That's as simple as I can make it. It's the way all
billing works."

NO DISCOUNTS FOR SOME

It is a bizarre paradox of American health care that the very people who
can least afford to pay are charged the most by hospitals. Every patient
receives a "sticker price" bill, but nearly everyone gets a hefty discount.

Everyone except the uninsured and under-insured.

At Hackensack, 6 percent to 8 percent of patients are expected to pay
sticker price, hospital officials said. As individuals, these patients lack
the bargaining clout of a large insurer. Few of these patients fight their
bills - they simply can't understand them. The lingo of costs and charges
is like a foreign language, and those with the biggest bills are usually
the sickest.

Congress was so concerned about these inflated prices, and the aggressive
way hospitals try to collect on debts, it held three hearings on the issue.

The victims are "being charged two to four times what people with health
insurance coverage pay for hospital services," Dr. Gerard Anderson,
director of the Johns Hopkins Center for Hospital Finance and Management,
said at a House committee hearing last June.

"They are the ones charged an arm and a leg in order to get one or the
other fixed," said Rep. Joe Barton, the Texas Republican and committee
chairman.

Dozens of class-action lawsuits in New Jersey and around the country are
questioning whether these billing practices are at odds with the tax-exempt
status that hospitals receive as charitable institutions.

Under fire, the nation's second largest hospital group - the
California-based Tenet Healthcare Corp. - has begun offering the uninsured
discounts that match those given to managed-care companies.

Meanwhile, a lawsuit in federal court against New Jersey's nine-hospital
Saint Barnabas Health Care System claims the inflated charges "discriminate
against the very uninsured patients who are supposed to benefit most."

New Jersey hospitals have the highest "sticker price" mark-ups in the
nation - their charges, on average, are four times higher than costs,
according to an analysis of 2002 data by the Institute for Health and
Socio-Economic Policy, affiliated with the California nurse's union.

At Hackensack, the sticker price is three to 3½ times costs.

But the revenue Hackensack receives doesn't come close to what it charges,
because of the heavy discounts to insurers. Hackensack took in just 28
cents for every dollar it charged in 2002, about average for hospitals in
New Jersey, according to the state Health Department.

Even so, the non-profit hospital doesn't lose money. It cleared $34 million
after expenses in 2003. Its parent corporation owns several profitable
subsidiaries. The medical center's president earns upwards of $1.2 million
a year.

Hospitals get away with high charges "because no one knows the true cost of
hospital services," said David Knowlton, a former state deputy health
commissioner and founder of the Health Care Payers Coalition.

Sean Hopkins, senior vice president for health economics at the New Jersey
Hospital Association, said the high charges are "the end result of a broken
payment system." This is what you get, he said, when Medicare and Medicaid
pay below break-even rates, and managed-care companies delay and deny
payments. Hospitals have to make it up somewhere.

Health care is a business - and Hogstrom has a business to run.

Unpaid bills are growing as employers scale back, raise deductibles or drop
health coverage, Hogstrom said. He's seen patients come in with health
plans that cover just five days in the hospital.

"The uninsured and the under-insured just become a bigger and bigger
problem every year," he said.

Hackensack tallied $68 million in bad debts last year, Hogstrom said. "Most
of it is little stuff," he said. At the same time, he said the hospital
provided $121 million - calculated at sticker price - worth of free care to
the indigent and received only $8 million back from the state for such
charity care.

"We're a medical center," he said. "We fix what's wrong with you, then we
talk to you about paying the bill. That's what we have to do."

AN AVALANCHE OF BILLS

Guido Osso was a complete invalid when Elia brought him home just before
Christmas in 1999.

"The saliva was drooling down," she remembered. "His mouth was crooked. He
was shaking."

Numerous strokes had damaged Guido's brain, impairing his vision, speech,
movement, and bladder and bowel control.

"I was lost," Elia said.

The bills soon started arriving from Hackensack University Medical Center.
After four months, a collection agency was sending them. By May 2002,
Hackensack had turned the Osso account over to a second collection agency,
Community Collections Inc. of Union.

Two statements arrived at Guido's house each month.

"It's that time," they said cheerfully, "when we would like to remind you
of the status of your account."

Hospital collections is a burgeoning business. Each year, collection
agencies interested in medical debts contact more than one in 10 American
families, according to a survey by the Kaiser Family Foundation. The debts
are rising so quickly, The Commonwealth Fund warned last year that "medical
bills and lingering medical debt are undermining the financial security of
American families."

The Ossos and the hospital disagree on some things. Elia says she sent the
collection agency a check for $100 a month - a total of $1,300 - before the
constable came knocking. The hospital says she was offered a $70-a-month
payment plan and didn't keep up, and that their collection agency was told
at one point that Guido had died.

Hospital officials offered in January to drop the bill to $80,000, even
though they said the Ossos didn't qualify for a discount. They said they
knew the family had the resources to pay. The Ossos said they didn't.

So the hospital went to court.

The collections attorneys who work for Hackensack University Medical Center
file dozens of legal actions each week against former patients over debts
that have ranged from $458 to Guido's $160,000. When the judge slams his
gavel and judgment is rendered, the only escape is death or bankruptcy.
Bank accounts, salaries, valuables like jewelry or a sports car, the
proceeds from home sales - the law allows the hospital to go after all of
these to get its money.

In the last five years, four major North Jersey hospitals have won
judgments against more than 1,700 people who owe money.

Hackensack won 517 cases from January 2000 to April 1 of this year,
according to court records. The medical center was an interested party in
14 foreclosures.

The Valley Hospital in Ridgewood won 688 judgments, Holy Name Hospital in
Teaneck 256, and Englewood Hospital and Medical Center 229, court records
show.

The lawsuits filed by the hospitals usually result in a default judgment -
few debtors have the money to hire a lawyer. A judgment allows the hospital
to put a lien on the debtor's property. That's what the Ossos feared - a
lien on the house that was to be Elia's security in old age.

Hogstrom defended Hackensack's lawsuits.

"Companies sue people who don't pay their bills all the time. If we don't
do that, we won't be here next year to take care of the patients who really
need it," Hogstrom said. He added, "We go very far, but we don't ever
really go to the point where we're going to put people in bankruptcy or
take away their house."

As an example, Hogstrom cited a couple who recently faced a hospital bill
of more than half a million dollars. When the couple, in their 60s, offered
to take out a reverse mortgage to pay the debt, the hospital refused
because it likely would have rendered the couple homeless within six
months. Hospital officials said they discounted the couple's bill, based on
their financial need, and devised an affordable monthly payment plan.

Hospitals, including Hackensack, are "committed to treating patients with
compassion - not only at the bedside, but at the billing office," said
Hopkins, the official with the state hospital association. "It's not, nor
should it be, our intention that a patient be bankrupted over a bill."

A RELENTLESS BURDEN

The note Elia found taped to her door last February said "urgent" and asked
her to call the constable. "We are attempting to personally deliver
important legal documents," it said. Elia was too scared to make the call.
She asked Sabrina to do it.

When the lawsuit was delivered the next day, Elia feared that she was
headed for financial ruin, and taking her children with her. After Elia
quit her job to care for her husband, the family had no income until
Guido's pension and Social Security kicked in recently. Their savings had
been depleted.

Once, family had been everything to her. But standing in her kitchen a few
days later, she told a visitor that her family didn't exist anymore. Her
heart broke to see her once powerful husband so completely dependent, she
said. Her son was still a boy when he lost the father he knew, and it made
her sad.

Christmas, New Year's, Easter - holidays were no different than other days,
lost beneath the burden of daily chores. "I change his diaper, I take him
to the doctor. I go get medicine, clean, wash and get food - that is my
life," she said.

When she first brought Guido home, Elia had to call an ambulance - and pay
hundreds of dollars - each time she took him to the doctor. Finally, a
physical therapist showed her how to maneuver his unwilling form up and
down the 17 steps from their apartment.

Elia paid for renovations to widen their bathroom door so that Guido's
wheelchair could roll in and out. She had to buy a hospital-style bed for
him. Last year, she stopped renting out the ground-floor apartment - losing
the rental income - so that Guido could stay there, and be taken in and out
more easily.

Their son, Michael, who'd been a student at Paramus Catholic High School,
had to transfer to a public school.

"We couldn't afford it anymore," Elia said.

She had hoped he would go on to a four-year college, but Michael now
attends Bergen Community College, while living at home to help look after
his dad.

Eighteen months after he stopped working, Guido's union health plan stopped
covering Elia and Michael. Elia paid $508 a month for insurance, but
couldn't afford it for long. Guido went without health insurance for two
years, until he turned 65 and qualified for Medicare.

"My worry is that my mom can incur more health bills than my father," said
Sabrina, the oldest daughter. "It's all stress. She doesn't care for
herself."

She was right. Elia's precarious personal and financial situation took a
terrible turn this spring, when she slipped while caring for her husband
and broke her right elbow. Susan heard her screams and came running. She
called an ambulance.

Through her pain, Elia asked to be taken to Holy Name Hospital, where she
qualified for charity care. Even so, she was required to pay a portion of
the hospital's charges, as well as the surgeon's fees. The family medical
bills, said Susan Osso, grew by more than $10,000.

The relentless burden has changed Elia.

"Look at me," she said recently. "I cry like a baby. I can't breathe. I
throw up. Nobody can help you."

She is so ashamed of her transformation that she asked that no photographs
be taken.

The Ossos have hired attorney Anthony Marucci. After The Record interviewed
hospital officials, the collection agency proposed a settlement, Marucci
said last week. He said the agency required secrecy about the terms of the
agreement - which includes money from both the family and the union - and
would not put it in writing. Marucci has sent the collection agency a
check, and hopes the settlement goes through.

For its part, the hospital said Friday that nothing had changed. It has had
no recent contact with the Ossos, said Pritchett, the vice president of
patient accounts.

Elia Osso hopes she never has to go to court.

But if she does, she'll bring Guido.

"She will wheel my father in from the ambulance," said Sabrina, "and say,
'Here we are. See it with your own eyes. This is what you're doing. We're
not just numbers.' "

* * *
STICKER SHOCK, HOSPITAL STYLE

Guido Osso was billed "sticker price" - the hospital's highest charges -
for his 1999 hospital stay. Here is a comparison of what Medicare would
have paid for some of the same services. Medicare rates are set by the
government to reflect actual average hospital costs.

SERVICE                         GUIDO
                                        OSSO'S
                                        BILL            MEDICARE
Chest X-ray                             $65             $28.91
Pulse oximetry, daily
(monitors oxygen level of blood)        $286            $ 50.71
Electrocardiogram                               $96             $18.32
Telemetry
(monitors and transmits data,
usually on cardiac function)            $1,025          $96.50
CT Scan of the head and brain           $1,115          $237.56
EEG (Electroencephalogram,
a record of the minute electrical
pulses produced by brain activity)      $590            $122.21

He was also charged marked-up prices for the medicine he received in the
hospital. A comparison of what he was billed and the average wholesale
price:

MEDICATION                      GUIDO   AVERAGE
                                        OSSO'S  WHOLESALE
                                        BILL            PRICE
Aspirin, 325 mg tablet                  14 cents        1 cent
Thiamine (Vitamin B-1)                  21 cents        3 cents
Prednisone                              29 cents        7 cents
Amlodopine (Norvasc) 2.5 mg             $7.17           $1.32
Zovirax, 500 mg vial                    $341.62 $50.90
Erythropoetic                           $606.17  $120

Sources: Empire Blue Cross Blue Shield; 1999 Drug Topics Red Book.

* * *
ANATOMY OF A HOSPITAL BILL

Guido Osso stayed at Hackensack University Medical Center for 38 days in
late 1999. His health coverage ran out on the 21st day - Osso was now
responsible for paying for all of his care. He no longer qualified for the
discount the hospital gives to health plans.

His bill:

Total charges for hospital stay from Oct. 15 to Nov. 22: $232,689.83

What Local 464A's health and welfare plan paid - its discounted rate for 21
days because of limits on plan coverage: $46,865.00

Telephone charges were not covered, and paid by the family at the time:
$70.00

The hospital subtracted this amount for unexplained reasons: $41,676.86

Hospital bill sent to Guido Osso: $144,077.97

If Osso had left the hospital the day his insurance ran out, he would have
owed nothing. Had Local 464A's health and welfare plan covered his entire
stay at the steep insurer discount, the hospital would have accepted this
as payment in full: $97,246.00
----------------------------------------------------------------------------
----
Osso stayed at Hackensack University Medical Center for another 18 days in
2000. The charges were higher, because he spent five days in
intensive-care.

Total charges for hospital stay, Feb. 1 to Feb. 19      $115,659.89
Amount paid by Local 464A's health and welfare plan     $64,769.53
The hospital discounted the bill and subtracted         $34,697.97
Hospital bill sent to Osso                              $16,192.38

Osso owes Hackensack University Medical Center:         $160,270.35
 

HOSPITAL JUDGMENTS AGAINST DEBTORS

When hospital billing departments and collection agencies fail, hospitals
can sue. A civil court judgment can be used to place a lien on a house,
garnish wages, or attach a bank account.

The number of judgments some North Jersey hospitals have won against
creditors since Jan. 1, 2000:

HOSPITAL                                                NUMBER OF
                                                        JUDGMENTS
The Valley Hospital, Ridgewood                  688
Hackensack University Medical Center                    517
Holy Name Hospital, Teaneck                             256
Englewood Hospital and Medical Center           229
Pascack Valley Hospital, Westwood                       39
St. Joseph's Regional Medical Center, Paterson          12
Barnert Hospital, Paterson                                        3

Source: Automated Case Management System of the Administrative Office of
the Courts, Jan. 1, 2000, to April 1, 2005.

* * *
DO YOU HAVE ENOUGH COVERAGE?

As employers cut back on benefits, or ask their workers to share more of
the cost of coverage, it's important to know what your health plan does -
and doesn't - cover. Ask about your plan's limits:
Are your out-of-pocket expenses open-ended? Most commercial insurance plans
cap the amount an individual or family would have to pay for deductibles
and co-payments. But not all plans do. Check your financial exposure.

Is there a maximum payout for the plan per year or over your lifetime? A
limit of $1 million or $2 million may seem like a lot of money, but a long
hospital stay with an organ transplant, for example, can ring up charges
quickly.

Does the health plan limit the number of days of hospital care that is
covered? Is that limit applied to a calendar year, a fiscal year, or a
lifetime?

If the health plan covers services such as physical and occupational
therapy, does it limit the number of visits? Once again, how is that limit
figured - per calendar year, fiscal year, or lifetime?

Even if you have insurance, your stay may not be covered because you
haven't met your plan's deductible or have exhausted your benefits. In
those cases, you may not receive your insurance company's discount and may
be billed full charges.

If you find yourself facing a large medical bill:

Work with the hospital's financial counselor to determine your eligibility
for charity care, Medicaid, or "compassionate billing." The entire family's
income and assets will be considered and documentation is required.
Different hospitals have different "compassionate billing" practices.

If you are sued for not paying a medical bill, get a lawyer. Most hospital
lawsuits against patient-debtors end up in a default judgment, because the
patient does not contest them. A lawyer can negotiate on your behalf - and
may secure a reduction in the bill.

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