The morning of Jan. 26 could have been another normal day of work for Geeta, until an approaching truck left her disabled in a blink of an eye, fracturing both of her femur bones and collarbone, breaking her right arm, and spraining her left wrist. Paramedics arrived. Police arrested the driver. Local media covered the incident. But for Geeta, 49, who now breathes on life support at Jersey City Medical Center, an RWJ Barnabas Health facility, upcoming medical bills are of greater concern. For Geeta and her husband affordable health care, especially emergency services, is unimaginable.
“Doctors are saying that it may take her nine to 10 months to recover completely,” says Geeta’s husband, who agreed to talk on condition of anonymity due to fears of revealing his immigration status publicly.
The couple are among the 252,000 undocumented residents of Jersey City – a figure estimated by the non-partisan think tank Migration Policy Institute – who lack access to health insurance. Options to tackle medical costs are limited, but they do exist.
Five days after the accident, relief came for Geeta’s husband, a 51-year-old supermarket cashier earning $9 per hour. A social worker introduced him to Charity Care, a state-funded payment assistance program aimed at covering costs for uninsured and underinsured residents.
Less restrictive documentation requirements pave the way for undocumented groups to access benefits offered by the program. Applicants are required to provide proof of identification, a bank statement, a proof-of-income letter, and a proof of address to qualify.
“We get thousands of applications per day and…yeah, many are indeed undocumented,” says Maria Fuentes, a Charity Care representative from Jersey City Medical Center. Citing patient confidentiality, she would not provide an estimate of applications submitted by undocumented patients.
According to the New Jersey Department of Health’s 2020 Documented Charity Care (DCC) report, Jersey City hospitals led the charts for DCC in Hudson County – a factor representing charity claims made by hospitals – with Jersey City Medical Center filing an average of $19.6 million in claims in last seven years, followed by $9.9 million in claims made by its counterpart Christ Hospital.
But for Geeta’s husband, a friend’s account casts doubt on the program’s commitment to protecting uninsured patients from hefty medical bills. Jose agreed to share his experience with Charity Care, but fearing that officials from RWJ Barnabas Health may approach him regarding unpaid bills, he refused to provide his last name.
“I signed up for [Charity Care] and still couldn’t get rid of those bills,” says Jose. “I go talk to the lady at the counter and I get told that I have to pay this much money on my own.” Jose, who works as a deliveryman for an Indian restaurant near Journal Square, recalls visiting the medical center’s emergency room last June after a fractured ankle left him with no other choice but to dial 911 for an ambulance.
Although Charity Care helped Jose escape the costs of an ambulance ride and medications totaling $1,012.68, an additional charge of $135.46 kept appearing on medical bills he received every month from Barnabas Health.
Fuentes pulls up a physical copy of a FAQ page that representatives like her are obligated to hand out to patients who complain about unexpected bills. She points to a bulleted list of services – pathology readings, private physician services, emergency room physician medical services – not covered by Charity Care at all.
Jose, who is 43 and comes from Guatemala, has depended on Charity Care for seven years. “This didn’t happen a few years ago,” he says. He recalls visiting the hospital’s emergency room for a chest pain he experienced in 2018 and receiving a free-of-cost medical service.
“We can’t really comment on it. You need to reach out to someone from the state,” says Stephanie Gonzales, a human resources coordinator from Jersey City Medical Center when asked about factors responsible for exempting crucial services such as emergency service fees from Charity Care.
Meanwhile, Eve McKenzie, a financial counselor from the hospital’s emergency ward, blames the pandemic for diverting resources from some of the hospital’s departments, including Charity Care. “If we are to blame someone, it has to be the pandemic, which basically led to a budget reallocation,” says McKenzie.
The NJ Department of Health’s 2020 DCC report states that charity claims fell across 60 hospitals in 2020 and increased in 11.
The New Jersey Department of Health has yet to respond to email inquiries regarding the possibility of recent shifts in the state’s funding of Charity Care.
“Both hospitals and state officials are undeniably major stakeholders when it comes to decision-making around such statewide subsidy,” says Dr. Ellen Kurtzman, a professor and executive director of health administration at Rutgers University’s Edward J. Bloustein School of Planning and Public Policy.
In light of the COVID-19 pandemic, New Jersey’s leading healthcare organizations showed their willingness to make healthcare more affordable. Around 17 institutions signed up for the New Jersey Health Care Cost Benchmark Program launched by Gov. Phil Murphy in December 2021. RWJ Barnabas Health is one of the signatories. “RWJ Barnabas Health is committed to making healthcare affordable for all the residents of New Jersey while continuing to enhance patient care and increasing access,” President and CEO Barry H. Ostrowsky said during the program’s announcement.
Despite such pronouncements, emergency room fees from Charity Care keep appearing on medical bills sent to former patients like Jose, charges he expected to be covered by Charity Care.
The plight does not end there. Even if patients manage to pay for services not reimbursed by Charity Care, they are pitted against “surprise medical bills” sent by out-of-network services a healthcare provider may use.
“I already paid my bills, so… I went there and said why do you keep sending me these bills,” says Jose, who received a medical bill from University Radiology a week after he paid his bill for emergency services. Upon hearing Jose’s complaint, a Charity Care representative told him the $300 bill reflected an x-ray charge provided by University Radiology, an out-of-network partner of RWJBarnabas Health.
This came months after the “No Surprise Act” came into effect on Jan 1, 2022. The billing act passed by Congress and signed into law by former President Donald Trump in 2020 prohibits surprise bills for emergency services and supplemental services such as radiology. It also requires providers to remain transparent about available protections against any surprise billings.
Dr. Kurtzman believes that surprise billing is deeply rooted in patients’ and providers’ failure to discuss billing estimates — including out-of-network service costs. “Part of the problem here is that these [undocumented patients] are unaware of their rights, and providers mostly prefer not to bother themselves sharing whether any out-of-network services were used at any point of treatment,” says Kurtzman.
More than the number of bills that appear in their mailboxes, recipients fear the consequences if a bill remains unpaid.
Jose maintains that two weeks after he received the unexpected bill from the radiology center, he started getting emails and calls from a debt collection agency reminding him to pay the sum he owes to University Radiology. Fearing that RWJ Barnabas Health would take legal action or send debt collection agents to his apartment, he moved to Bayonne in November.
“To give you a reality-check, there are no federal or state protections in place that can encourage them to speak against all sorts of grievances, be it at the workplace, at schools or even hospitals,” says Raymond Lo, a Jersey City-based immigration lawyer.
While Geeta waits to get back on her feet, her husband grows anxious every day remembering his friend’s experience with the debt-collection agency. But at the core of his restlessness are fears of medical bills accumulating to thousands of dollars, and a shaken confidence in Charity Care’s ability to live up to its commitments of “free and reduced charge care.”
“I don’t know what to do or who to speak to,” he says.