Part 2 of a four-part series examining how competing truths over consolidation impact a health system and its community.
JOHNSON CITY, Tenn.—When Danielle Sparrow quit her job to care for her youngest son, she stopped making monthly payments on a 2017 hospital bill.
The 38-year-old single mom, who lives in Church Hill, Tenn., said she was too overwhelmed at the time to call Ballad Health, and expected the health system would send her to collections on the remaining balance from her visit to Holston Valley Medical Center's emergency department in Kingsport for chest pain. But Sparrow said before she received any collection notices, Ballad sued her in August.
Sparrow said she has since worked out a payment plan on the $1,300 bill, which she received when she had employer-sponsored health insurance. She’s now busy raising three adopted children, ages 1, 3 and 5, all born drug-addicted, as well as three foster children, ages 9, 12 and 15.
Her youngest adopted son has a rare disorder called Smith-Magenis syndrome, the features of which include intellectual disability, delayed speech and behavioral problems like hair pulling, biting and head banging.
Sparrow said she works part time for a grocery delivery service but can’t work full-time because she takes her son to at least four medical appointments each week, including physical, occupational, speech and feeding therapy.
“So here I am, just adopted three children … working as much as I can and now I’m being sued,” she said. “What do I do?”
Ballad officials said they filed about 5,700 lawsuits against patients in its first fiscal year as a health system, which ended in June. That’s up from nearly 5,400 in the prior year, which ended June 2018, four months after its merger became official. They say they are simply trying to collect revenue that is the responsibility of the patient. Ballad's bad debt in fiscal 2019 was $141.2 million.
The not-for-profit health system has also filed roughly 900 liens in two Tennessee counties since it was formed.
What residents see as a more aggressive collections tactic is just one of the issues post-merger that's of concern to the community. Consolidated service lines, staffing issues, access to care and lack of transparency are others.
Ballad executives could not discuss specific lawsuits without signed privacy releases from patients, but CEO Alan Levine, said in Sparrow’s case, all of the protocols were followed.
“We are human and that’s not to say that there are not circumstances where there’s an oversight or there’s a mistake—that can certainly happen,” he said. “I am 100% certain in the cases that you provided to us, that that is not the case.”
Ballad contacts a patient a minimum of seven times in the 120-day window between a late payment and sending them to collections, said Lynn Krutak, the system’s chief financial officer. After that, she said the collection agency works with those patients for another 90 days.
Sparrow said she did not once hear from a collection agency in any form before the lawsuit.
“No phone calls, nothing in the mail, nothing,” she said.
Most of Ballad’s lawsuits are in Washington and Sullivan counties, where its two largest hospitals, Johnson City Medical Center in Johnson City and Holston Valley in Kingsport, are located. Ballad has filed nearly 400 lawsuits in Greene County, where it has two hospitals.