We the Patients

Financial Aid dispute puts family under financial distress

Hospital puts up roadblocks to financial assistance every step of the way – Oliwia Caes, NYC

A parent’s greatest fear, their child suddenly falling ill. What’s worse? When they stop and think, what should I do? I can’t afford to go to the doctor. This was Dorata Caes dilemma.

Her 12-year-old daughter, Oliwia Caes, was sent to the emergency room at Mount Sinai for an emergency appendectomy. After discharge, Dorata received bills totaling $3,344. Her United insurance plan had reimbursed only 80%, and Dorata and her husband were supposed to pay the rest.

Immediately, Dorata looked to hospital financial assistance but, the bill only gave cryptic information about its “assistance programs” and provided an incorrect phone number. Staff at Mount Sinai were not cooperative. Dorata met roadblocks every step of the way – from the wrong address on the website to wild goose chases trying to track down a person who could help, to unreturned calls, to misinformation about deadlines. One time, a member of the staff refused to accept an application that Dorata had tried to deliver in person. The staff member said – incorrectly — that it was past the deadline.

By the time Dorata reached out for help, her family was getting debt collection notices. This is illegal. Hospital Financial Assistance Law (HFAL) prohibits sending any bill into collections while a financial aid application is pending. Dorata’s advocate found another violations of HFAL, the hospital failed to disclose financial assistance policies.

After submitting a new application, Oliwia was awarded a disappointingly small discount. Dorata appealed the decision, showing that her family could not afford the bill and needed more help. Finally, after many months of worry, Dorata received approval. Her final bill came to $99.50.

Tired of hearing cases like Oliwia’s? In New York you can take action to help standardize financial assistance forms and reduce the barriers to gaining access to these funds. You can learn more here.