Helping Parents Focus on Their Child’s Care, Not How to Pay for It

No Strings Attached

Seattle Children’s commitment to uncompensated care helps families focus on their child’s health rather than the cost of the medical care needed to restore it.

Hardy family

Lifesaving heart surgeries gave Ansley Hardy, 5, (pictured with mom Marci and brother Marik, 8) a clean bill of health – and her parents never had to worry about paying their medical bills.

Ansley Hardy’s parents were shocked to learn that their new baby had a life-threatening heart condition.

“She didn’t pink up like other newborns,” remembers Ansley’s mom, Marci Hardy.

Within hours, Ansley and her dad Blaine Hardy were airlifted from Helena, Mont., to Seattle Children’s while Marci recovered from a caesarean section.

The news from Seattle was grim.

“Ansley’s heart wasn’t circulating oxygenated blood to her body because the two major vessels that carry blood away from her heart were switched,”explains her mom. “She was literally suffocating to death, but at every step she just kept pulling through.”

Ansley’s condition, called transposition of the great vessels, required three surgeries at Seattle Children’s and hospital stays in Seattle and Helena – care that could have exceeded the $1 million cap on the family’s health care plan by as much as $500,000.

When a Seattle Children’s social worker suggested they apply for financial assistance, Marci Hardy was reluctant to ask for help.

123,833 children received uncompensated care in 2011.

“I was a stay-at-home mom, but Blaine had a good job and we weren’t poor,” she says.

The social worker convinced the couple to fill out the application by asking them if they’d really be able to absorb any costs their insurance didn’t pay.

“We were beyond elated and forever grateful when Children’s sent us a letter saying we qualified for financial assistance,” says Ansley’s mom. “Without it, we might have lost everything we had, and our parents and grandparents would have sold everything they had to help us pay our bill. It would have changed the course of our life and the lives of our family.”

A worthy promise

Gary Ostendorf

The financial assistance specialists at Seattle Children’s serve as touch points for families struggling with medical bills. “I help families ask the money questions they don’t know to ask or are afraid to ask,” says Gary Ostendorf, financial counselor.

Since opening our doors in 1907, we’ve kept our promise to provide all necessary medical care to kids in our region – Washington, Alaska, Montana and Idaho – regardless of a family’s ability to pay.

In 2011, Seattle Children’s picked up the tab for $103.4 million in care that was not otherwise paid for.

Approximately $10.7 million of that total covered unpaid medical services – costs that families incurred for care beyond their ability to pay.

The rest of the total – a whopping $92.7 million – covered payment shortfalls from Medicaid, the government program that provides medical coverage at no cost to low income families. Nearly half of our patients are covered by Medicaid, but the program reimbursed us for only 71% of the real cost of treatment.

By filling in the gaps left by Medicaid shortfalls or a family’s inability to pay, Seattle Children’s helps parents focus on what’s most important – the health and well being of their child.

Approximately 12% of the $103.4 million in uncompensated care provided by Seattle Children’s in 2011 came from philanthropic contributions like the Auction of Washington Wines, an event that celebrated its 25th anniversary this summer.

“To have a resource like Children’s is one of the great blessings of our community,” says Bob Betz, a winemaker from Woodinville, Wash., who has participated in the auction since its inception. “The hospital is dear to my heart and I believe we have a duty to support the incredible care that’s available there for any child in our region who needs it.”

Protecting the piggy bank

Atkins family

Jessie Atkins and daughter Acashia, 10, play with Stage, 6. “Every time someone reaches in their pocket and makes a donation to Children’s, it’s a gift they’re giving to our family, to our son and to society,” says Atkins.

Jessie Atkins suspected something wasn’t right when she heard her son’s cries in the delivery room.

“The nurses and doctors told me he was fine, but I knew in my heart something was going on.”

Her intuition was spot-on.

Though friends and neighbors initially passed off concerning symptoms like poor weight gain, excessive sleep and screaming until blue in the face as colic, Stage was soon diagnosed as having seizures. At the age of 3 weeks, he was having up to 15 a day.

When the state medical insurance that covers moms and babies for the first year of a child’s life ended, Stage’s medically fragile condition did not.

Atkins panicked and called Seattle Children’s to cancel all of their appointments, explaining that she’d reschedule when she and her husband Jeff could figure out how to pay.

“A social worker called me back to find out what was going on,” remembers Atkins. “I told him I was overwhelmed and afraid that we’d lose our house. That’s when he said, ‘Do you know that we have a program that might be able to help you?’”

For Atkins, Seattle Children’s commitment to providing uncompensated care means that her family doesn’t have to choose between paying the mortgage on their house in Marysville, Wash., and getting their son the care, prescriptions and medical supplies he needs – more than $15,000 a year in costs that their private insurance doesn’t cover.

“Our son’s fragile health brings so many worries every day, but we never worry about receiving a bill from Children’s.”

Jessie Atkins, mom

“When you have a child like Stage, people automatically think there are state services to help,” explains Atkins. “I’m here to tell you, state services for children are only available for low-income families. Children’s financial assistance helps us keep Stage healthy, put some money away for our daughter’s college education and hold onto what little financial security we have.”

A safety net

Casey James

A childhood of medical care, like that of Casey James (from left, with nurse practitioner Kate Greenleaf and nurse Makayla Ramirez), can cost well over $2 million. When his insurance co-pays threatened to bankrupt his parents, Seattle Children’s was there to help.

Life is good for Casey James. Now 19 and fresh out of high school in Gig Harbor, Wash., Casey’s got a good part-time job, he’s studying video production at a local technical college, and he’s doing other things he loves, like hanging out with his girlfriend and skate-, wake- and snowboarding with his buddies.

There’s just one thing that sets Casey apart from his peers: “I wouldn’t be here today without Children’s.”

Casey was born with posterior urethral valve (PUV) disorder – a condition that blocked the normal flow of urine and left him with a damaged bladder and only one functioning kidney.

“I changed jobs to work for a company that had much better insurance, because I knew my son would need lots of care,” explains Jo James, Casey’s mom.

Initially, her insurance covered all of Casey’s care. Then the economy flagged and her company raised the employees’ co-pay for health insurance and medical care. And compounding the issue, the small business owned by her husband Dave James failed.

Joseph Tutnutmoak

Joseph Tutnutmoak, 14, lives in Chevak, Alaska. He suffered acute liver failure in January 2011 and was airlifted to Seattle Children’s – 2,000 miles away – for a transplant. Medicaid covered 71% of his care; Children’s picked up the rest.

“A 15% co-pay may not sound like much to someone who doesn’t often need medical care,” says James. “But Casey’s care runs anywhere between $10,000 to $15,000 per month. With Dave out of work, we just couldn’t keep up.”

When James saw information about Seattle Children’s financial assistance printed on one of Casey’s bills, she picked up the phone.

“We were on the brink of financial ruin and now we don’t even see a Children’s bill,” notes James. “Children’s pays the 15% co-pay that we’re not able to cover. I can’t tell you how wonderful that is.”

Published in Connection magazine, December 2012