A new report finds that large Colorado hospital systems are not adequately telling consumers about their rights and access to discounts, state hospitals argue.

The report from the nonprofit organization Colorado Consumer Health Initiative (CCHI) found that less than 60 percent of hospitals are fully compliant Hospital Discounted Care (HDC) Act.that the legislature passed in 2022 in an effort to make bills more affordable for low- and moderate-income residents.

By law, hospitals must inform patients of their rights, screen them to see if they qualify for financial help, and offer discounts to patients who do.

CCHI reviewed websites and made phone calls in English and Spanish to 89 hospitals.

Fifty-eight percent met requirements such as posting a “uniform application, English-speaking patient rights, Spanish-speaking patient rights, landing page link to low-cost hospital care information, and posting information in a visible manner”. according to a press release.

When CCHI’s “sample patients” made phone calls to hospitals asking about reduced care options, 11 percent provided adequate information.

Of nearly 180 calls, 20 resulted in what the group called a “successful outcome,” meaning the caller was able to obtain useful and accurate information about HDC. The percentage was much lower for calls made in Spanish (4.5% versus 18% for English).

“The information was there, but absolutely not at the level we wanted it to be,” Sophia Hennessy, CCHI’s policy and research coordinator, said in an interview. “I think our report just focuses on, ‘Is there any information for consumers about this law that we have here in Colorado?’ And the impetus for this report was really rooted in people who are struggling with their medical bills.”

HDC law require hospitals to screen uninsured patients for eligibility for state programs such as Health First Colorado (Medicaid)and Children’s Health Plan Plus. They must also provide care at a reduced rate to anyone with a lower household income 250% of the federal poverty linewhich is about $3,137 per month for an individual and $6,500 per month for a family of 4.

View from hospitals

A spokeswoman for the Colorado Hospital Association said hospitals are trying to comply with the law and provide financial aid to those who need it, with rates skyrocketing, in part because hospitals are complying with the Affordable Care Act.

“Hospitals work diligently every day to comply with both state and federal laws,” said Julie Lonborg, the facility’s senior vice president and chief of staff. Colorado Hospital Associationin an interview. She said the past six years, according to CHA’s accounting, that includes 542 new Colorado state laws affecting hospitals. “So it’s a big task when we look at it and we work really hard at it every day.”

Lonborg disputed the phone call section of the CCHI report, saying those calls are not part of the regulation, which the nonprofit itself notes on page 12 of the document. report: “Although there are no phone call regulations in Colorado’s HDC law, we chose to call hospitals to measure the consumer experience of accessing HDC information from the facilities.”

“There is nothing that is a rule or regulation in the statute about how phone calls should be handled,” Lonborg said.

Lonborg said that because of HDC, many people are now receiving care at Colorado hospitals through the program, with 212,000 patients, as reported by 73 hospitals that turned over data in the state.

The rate of charity care—financial assistance, free or discounted care given to people who cannot afford to pay for it themselves—reported by hospitals continues to rise sharply. CHA estimated it has grown 60 percent in the past year and more than 150 percent since before the COVID-19 pandemic

The group said this is due to an increase in the number of patients applying for and getting coverage through the HDC program, plus hundreds of thousands of Coloradans finding themselves without coverage because they were dropped from Medicaid. “That’s as far as this works for us,” Lonbong said.

A patient’s perspective

“It’s like I’m really making it as hard as possible,” said Kristanna Hall, a 31-year-old mother and former Broomfield resident. Hospitals offer reduced care “because they have to legally, and they make it as difficult, time-consuming and frustrating as possible.”

In 2023, her son Niklaus was born prematurely at 34 weeks after a high-risk pregnancy. He caught COVID-19 and was isolated in a hospital’s NICU, the neonatal intensive care unit. He had a number of problems, including respiratory distress.

Courtesy of Kristianna Hall

“We had almost a million dollars billed to our insurance last year. And I am not exaggerating this figure. The 34 day stay for his NICU time alone was over $300,000 for that part. So, needless to say, medical costs can be extremely high, especially for small families,” said Hall, who recently moved to Texas.

While pregnant with her son, she had been laid off from her job in the mortgage industry.

All told, she had several hospital admissions and a C-section, plus NICU stays and follow-up appointments. The medical care they received took them to three hospitals, several specialists and required an ambulance ride.

Hall said she qualified for reduced care, but then had difficulty with the applications. Each unit seemed to have a different way of handling it.

“One person would like to call you by appointment only, the other person would like you to come in person,” Hall said. “The other, you go through a phone tree of a hundred people and then maybe we’re lucky to try and get a call back. There was nothing like it that made everything simple or easy.”

Hall said he was able to negotiate and get his out-of-pocket costs down to $7,000 for last year, but it took what seemed like endless phone calls and emails.

“It took a lot of hard work to even get to that point,” Hall said. “It’s just this overwhelming, overwhelming experience.”