Mass shooting victims face large uncovered medical and long-term care costs

The ongoing American epidemic of mass shootings is forcing hospitals to develop new skills in helping patients with large medical costs.

It's also spotlighting serious gaps in insurance coverage for medical and long-term care. Hospitals in Fort Worth, Texas, Las Vegas, San Bernardino, Calif., Aurora, Colo., Orlando, Fla., Newtown, Conn. and other areas have had to help shooting victims cope with major uncovered costs. Such costs include inpatient care, follow-up surgeries and other treatments, mental healthcare, rehabilitation and skilled-nursing care, durable medical equipment, personal care, and living costs while the patients are not able to work. The needs have been exacerbated by the proliferation of health plans with high deductibles and coinsurance requirements, leaving patients exposed to many thousands of dollars in cost-sharing. Severely injured patients needing repeat surgeries may hit their out-of-pocket spending limits multiple years in a row, forcing them into bankruptcy. On top of that, even insured patients may face big balance bills if they are treated by out-of-network providers. "There are enormous costs involved in living with a gun injury," said Dania Palanker, an insurance expert at Georgetown University's Health Policy Institute. "For many people those costs, such as personal care support, are not considered medical care by our insurance system." A number of hospitals treating victims of mass shootings, such as Sunrise Hospital & Medical Center and Dignity Health's St. Rose Dominican in Las Vegas, have announced policies of reducing or waiving payments from these patients. But that only addresses part of the financial issue. Orlando Health wrote off a balance totaling nearly $5 million for the 135 patients it has treated from the Pulse nightclub shooting in June 2016, which left 49 dead and 58 wounded. In addition, its staff has worked closely with the patients and their families to find ways to finance their continuing medical and long-term care needs, said Michele Napier, the system's chief revenue officer. "Orlando Health felt this was a tragedy and a crime against humanity, so we decided to write off patient responsibility for those patients," she said. Many of the patients faced deductibles in the range of $3,500 plus coinsurance that they had not budgeted for, which is why the system worked with the patients' insurers to waive those out-of-pocket responsibilities. But she and her staff knew that wouldn't solve the patients' long-term needs. They recognized they would have to help the patients find funding sources to support them with those needs so they could recover their lives. Patients with gunshot injuries may require extensive rehabilitation, physical therapy, speech therapy, high-end wheelchairs, home modifications and long-term mental healthcare. Even patients with insurance may have limited or no coverage for such services, Napier said.

Orlando Health's financial assistance unit has worked to set people up with insurance through the Affordable Care Act exchange or Medicaid, or to help them receive aid through the city-managed One Orlando Fund. It would have been easier to get patients covered if Florida had expanded Medicaid to low-income adults, she added.

For shooting victims and their families who don't receive assistance like Orlando Health offered, it's a part-time job to manage the bills and arrange all the services, particularly if a person needs highly specialized care away from their hometown, Palanker said. Nevada Sens. Catherine Cortez Masto and Dean Heller recently urged the heads of America's Health Insurance Plans and the Blue Cross and Blue Shield Association to have their member plans review their policies to provide more generous coverage to the hundreds of people injured in the mass shooting in Las Vegas in October. They asked plans to waive deductibles, copayments and out-of-network charges. Still, shooting victims face many costs that will never be covered by insurance, such as hiring helpers to clean their home and prepare their food as well as covering their living expenses while they're out of work. Relatives and friends of many mass shooting victims, even those with good employer health benefits, have had to set up GoFundMe crowdsourcing donation sites to help with the bills. This raises the broader issue of how to enable people who are partly disabled to continue working, rather than giving them no alternative but to apply for Social Security Disability and Medicaid. "We need to start a conversation about providing some type of support to people who don't meet the definition of disability for Social Security purposes, to cover the pieces we don't think of as traditional medical care," Palanker said. "Is this something society wants to help cover?