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A Mom Owed Nearly $102,000 for Hospital Care. Her State Attorney General Said to
Pay Up.
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Search KFF Health News Search KFF Health News
Bridget Narsh at her home in Chapel Hill, North Carolina. Narsh's son, Mason,
lives with autism, post-traumatic stress disorder, and ADHD. In 2020, his
struggles required him to be hospitalized for more than 100 days. (Eamon Queeney
for KFF Health News)


A MOM OWED NEARLY $102,000 FOR HOSPITAL CARE. HER STATE ATTORNEY GENERAL SAID TO
PAY UP.

By Fred Clasen-Kelly July 20, 2023

Republish This Story

This story also ran on NPR. It can be republished for free.


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Bridget Narsh’s son, Mason, needed urgent help in January 2020, so she was
offered the chance to send him to Central Regional Hospital, a state-run mental
health facility in Butner, North Carolina.

The teen, who deals with autism and post-traumatic stress and
attention-deficit/hyperactivity disorders, had started destroying furniture and
running away from home. His mother worried for the safety of Mason and the rest
of the family.

But children in crisis in North Carolina can wait weeks or months for a
psychiatric bed because the state lacks the services to meet demand. And when
spots do become available, they are expensive.

The standard rate at Central Regional was $1,338 a day, which Narsh could not
afford. So, when a patient relations representative offered a discounted rate of
less than $60 a day, her husband, Nathan, signed an agreement.

Mason, now 17, was hospitalized for more than 100 days in Central Regional over
two separate stays that year, documents show.

But when requests for payment arrived the following year, Narsh said she was
shocked. The letters — which were marked “final notice” and requested immediate
payment — were signed by a paralegal in the office of Josh Stein, North
Carolina’s attorney general. The total bill, $101,546.49, was significantly more
than the roughly $6,700 the Narshes expected to pay under their agreement with
the hospital.

“I had to tell myself to keep my cool,” said Bridget Narsh, 44, who lives with
her husband and three children in Chapel Hill. “There is no way I could pay for
this.”

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Medical bills have upended the lives of millions of Americans, with hospitals
putting liens on homes and pushing many people into bankruptcy. In recent years,
lawmakers have railed against privately operated hospitals, and states have
passed laws intended to make medical billing more transparent and limit
aggressive debt collection tactics.

Some state attorneys general — as their states’ top law enforcement officials —
have pursued efforts to shield residents from harmful billing and debt
collection practices. But in the name of protecting taxpayer resources, their
offices are also often responsible for collecting unpaid debts for state-run
facilities, which can put them in a contradictive position.

Stein, a Democrat running for governor in 2024, has made hospital consolidation
and health care price transparency a key issue during his time in office.

“I have real concerns about this trend,” Stein said in 2021 about the state’s
wave of hospital consolidations. “Hospital system pricing is closely related to
this issue, as consolidations drive up already inordinate health care costs.”

Stein refused an interview request about Mason’s bills, which arrived at the end
of 2021 because the North Carolina government suspended debt collection in March
2020 as the nation felt the economic fallout of the covid-19 pandemic.

Across the nation, states seize money or assets, file lawsuits, or take other
steps to collect debts from people who stay at state-run hospitals and other
institutions, and their efforts can disproportionately affect racial and ethnic
minorities and the poor, according to health care consumer advocates. In North
Carolina, officials looking to collect unpaid debt are permitted to garnish
residents’ income tax refunds.

A debt collection letter from the North Carolina attorney general’s office asks
for immediate payment for Mason Narsh’s treatment at Central Regional Hospital,
which billed the Narsh family nearly $102,000 for Mason’s hospitalizations.
(Eamon Queeney for KFF Health News)
The letter shocked Bridget Narsh. “I had to tell myself to keep my cool,” she
says. “There is no way I could pay for this.” (Eamon Queeney for KFF Health
News)

Attorneys general must balance their traditional role of protecting consumers
from harmful debt collection practices and the state’s obligation to serve
taxpayers’ interests and fund services, said Vikas Saini, a cardiologist and the
president of the Lown Institute, a Massachusetts-based nonpartisan think tank
that advocates for health care reform.

The Narsh case is “the perfect storm of every problem in our health care
system,” said Saini, who at the request of KFF Health News reviewed the payment
demand letters the family received. Far too often health care is unaffordable,
billing is not transparent, and patients end up facing enormous financial
burdens because they or a loved one is sick, Saini said.

The Narsh family had Blue Cross and Blue Shield health insurance at the time of
Mason’s hospitalizations. Bridget Narsh has records showing insurance paid about
$7,200 for one of his stays. (Mason is now covered by Medicaid, the
state-federal health insurance that covers some people with disabilities and
low-income people.)

In a written statement, Nazneen Ahmed, a spokesperson for Stein’s office, said
state law requires most agencies to send their unpaid debts to the state
Department of Justice, which is charged with contacting people who may owe
money.

Ahmed directed KFF Health News to the North Carolina Department of Health and
Human Services, which oversees Central Regional Hospital.

Bailey Pennington Allison, an agency spokesperson, said in a written statement
that officials researched the Narsh case and determined the state had properly
followed procedures in billing the family.

The state bases its rates for services on the costs of the treatment, nursing,
professional consultation, hospital room, meals, and laundry, Pennington Allison
said. Hospital staffers then work with patients and families to learn about
their income and assets to determine what they can afford and what they will be
charged, she said.

The spokesperson did not address why Mason’s parents were offered, but did not
ultimately receive, a discounted rate both times he was admitted in 2020.

Narsh contacted an attorney, who negotiated the bill with the state. In April,
her family reached an agreement with North Carolina officials to pay $100 a
month in exchange for the state reducing the charges by roughly 96% to about
$4,300. If Narsh defaults, however, the deal stipulates she must come up with
the original total.

States can take a variety of approaches to debt collection. North Carolina is
one of about a dozen that can garnish residents’ income tax refunds, said
Richard Gundling, a senior vice president for the Healthcare Financial
Management Association, a membership organization for finance professionals.

Mason and his service dog, Koko, attend school, as seen on the phone of his
mom.(Eamon Queeney for KFF Health News)

Gundling said state officials have a responsibility to protect taxpayer money
and collect what is owed but that seizing income tax returns can have more
severe consequences for people with lower incomes. “There is a balance that
needs to be struck to be reasonable,” he said.

With health care a leading cause of personal debt, unpaid medical bills have
become a major political issue in North Carolina.

State lawmakers are considering a bill called the Medical Debt De-Weaponization
Act, which would curb the ability of debt collectors to engage in “extraordinary
collection” such as foreclosing on a patient’s home or garnishing wages. But the
current version of the bill would not apply to state-operated health care
facilities like the one Mason Narsh went to, according to Pennington Allison.

In a written statement, Stein said he supports legislative efforts to strengthen
consumer protections.

“Every North Carolinian should be able to get the health care they need without
being overwhelmed by debt,” Stein said. He called the bill under consideration
“a step in the right direction.”

Narsh said the unexpectedly high amount of the bill was frustrating, at least in
part because for years she struggled to get Mason more affordable, preventive
care in North Carolina. Narsh said she had difficulty finding services for
people with behavioral issues, a shortage acknowledged in a state report
released last year.

Multiple times, she said, she has been left with no option but to take him to a
hospital to be evaluated and admitted to an inpatient mental health facility not
suitable for people with complex needs.

Community-based services that allow people to receive treatment at home can help
them avoid the need for psychiatric hospitals in the first place, Narsh said.
Mason’s condition improved after he received a service dog trained to help
people with autism, among other community services, Narsh says.

Corye Dunn is the public policy director at Disability Rights North Carolina, a
Raleigh-based nonprofit mandated by the federal government to monitor public
facilities and services to protect people with disabilities from abuse. The
irony, she said, is that the same system that’s ill-equipped to prevent people
from falling into crisis can then pursue them with big bills.

“This is bad public policy. This is bad health care,” Dunn said.

Fred Clasen-Kelly: fredck@kff.org, @fred_ckelly


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 * Health Care Costs
 * Insurance
 * States
 * The Health Law
 * Bill Of The Month
 * Hospitals
 * Investigation
 * North Carolina

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COPY AND PASTE TO REPUBLISH THIS STORY


A MOM OWED NEARLY $102,000 FOR HOSPITAL CARE. HER STATE ATTORNEY GENERAL SAID TO
PAY UP.

By Fred Clasen-Kelly July 20, 2023

Article HTML <h1>A Mom Owed Nearly $102,000 for Hospital Care. Her State
Attorney General Said to Pay Up.</h1> <span class="byline">Fred
Clasen-Kelly</span> <p>Bridget Narsh’s son, Mason, needed urgent help in January
2020, so she was offered the chance to send him to Central Regional Hospital, a
state-run mental health facility in Butner, North Carolina.</p> <p>The teen, who
deals with autism and post-traumatic stress and attention-deficit/hyperactivity
disorders, had started destroying furniture and running away from home. His
mother worried for the safety of Mason and the rest of the family.</p> <p>But
children in crisis in North Carolina can wait weeks or months for a psychiatric
bed because the state lacks the services to meet demand. And when spots do
become available, they are expensive.</p> <p>The standard rate at Central
Regional was $1,338 a day, which Narsh could not afford. So, when a patient
relations representative offered a discounted rate of less than $60 a day, her
husband, Nathan, signed an agreement.</p> <p>Mason, now 17, was hospitalized for
more than 100 days in Central Regional over two separate stays that year,
documents show.</p> <p>But when requests for payment arrived the following year,
Narsh said she was shocked. The letters — which were marked “final notice” and
requested immediate payment — were signed by a paralegal in the office of Josh
Stein, North Carolina’s attorney general. The total bill, $101,546.49, was
significantly more than the roughly $6,700 the Narshes expected to pay under
their agreement with the hospital.</p> <p>“I had to tell myself to keep my
cool,” said Bridget Narsh, 44, who lives with her husband and three children in
Chapel Hill. “There is no way I could pay for this.”</p> <p>Medical bills have
<a href="https://kffhealthnews.org/news/tag/bill-of-the-month/">upended the
lives of millions</a> of Americans, with hospitals putting <a
href="https://files.consumerfinance.gov/f/documents/cfpb_medical-debt-burden-in-the-united-states_report_2022-03.pdf">liens
on homes</a> and pushing many people into bankruptcy. In recent years, lawmakers
have railed against privately operated hospitals, and <a
href="https://www.ncsl.org/state-legislatures-news/details/medical-debt-how-states-are-supporting-consumers">states
have passed laws</a> intended to make medical billing more transparent and limit
<a
href="https://kffhealthnews.org/news/article/how-to-avoid-surprise-bills-no-suprises-act-pitfalls/">aggressive
debt collection</a> tactics.</p> <p>Some state attorneys general — as their
states’ top law enforcement officials — have pursued efforts to shield residents
from harmful billing and debt collection practices. But in the name of
protecting taxpayer resources, their offices are also often responsible for
collecting unpaid debts for state-run facilities, which can put them in a
contradictive position.</p> <p>Stein, a Democrat <a
href="https://www.joshstein.org/">running for governor</a> in 2024, has made
hospital consolidation and <a
href="https://ncdoj.gov/attorney-general-josh-stein-releases-health-care-price-transparency-report-card/">health
care price transparency a key issue</a> during his time in office.</p> <p>“I
have real concerns about this trend,” Stein said in 2021 about the state’s wave
of hospital consolidations. “Hospital system pricing is closely related to this
issue, as consolidations drive up already inordinate health care costs.”</p>
<p>Stein refused an interview request about Mason’s bills, which arrived at the
end of 2021 because the North Carolina government <a
href="https://ncdoj.gov/attorney-general-josh-stein-takes-additional-steps-to-protect-north-carolina-consumers-during-covid-19-pandemic/">suspended
debt collection</a> in March 2020 as the nation felt the economic fallout of the
covid-19 pandemic.</p> <p>Across the nation, states seize money or assets, file
lawsuits, or take other steps to collect debts from people who stay at state-run
hospitals and other institutions, and their efforts can disproportionately <a
href="https://smhttp-ssl-58547.nexcesscdn.net/nycss/images/uploads/pubs/SUNY_Uptate_Hospital_Medical_Debt_V3.pdf">affect
racial and ethnic minorities</a> and the poor, according to health care consumer
advocates. In North Carolina, officials looking to collect unpaid debt are
permitted to <a
href="https://www.ncdor.gov/local-government/debt-setoff-unit">garnish
residents’ income tax refunds</a>.</p> <!-- image-left --> <!-- image-right -->
<p>Attorneys general must balance their traditional role of protecting consumers
from harmful debt collection practices and the state’s obligation to serve
taxpayers’ interests and fund services, said Vikas Saini, a cardiologist and the
president of the Lown Institute, a <a
href="https://lowninstitute.org/about/">Massachusetts-based nonpartisan think
tank</a> that advocates for health care reform.</p> <p>The Narsh case is “the
perfect storm of every problem in our health care system,” said Saini, who at
the request of KFF Health News reviewed the payment demand letters the family
received. Far too often health care is unaffordable, billing is not transparent,
and patients end up facing enormous financial burdens because they or a loved
one is sick, Saini said.</p> <p>The Narsh family had Blue Cross and Blue Shield
health insurance at the time of Mason’s hospitalizations. Bridget Narsh has
records showing insurance paid about $7,200 for one of his stays. (Mason is now
covered by Medicaid, the state-federal health insurance that covers some people
with disabilities and low-income people.)</p> <p>In a written statement, Nazneen
Ahmed, a spokesperson for Stein’s office, said state law requires most agencies
to send their unpaid debts to the state Department of Justice, which is charged
with contacting people who may owe money.</p> <p>Ahmed directed KFF Health News
to the North Carolina Department of Health and Human Services, which oversees
Central Regional Hospital.</p> <p>Bailey Pennington Allison, an agency
spokesperson, said in a written statement that officials researched the Narsh
case and determined the state had properly followed procedures in billing the
family.</p> <p>The state bases its rates for services on the costs of the
treatment, nursing, professional consultation, hospital room, meals, and
laundry, Pennington Allison said. Hospital staffers then work with patients and
families to learn about their income and assets to determine what they can
afford and what they will be charged, she said.</p> <p>The spokesperson did not
address why Mason’s parents were offered, but did not ultimately receive, a
discounted rate both times he was admitted in 2020.</p> <p>Narsh contacted an
attorney, who negotiated the bill with the state. In April, her family reached
an agreement with North Carolina officials to pay $100 a month in exchange for
the state reducing the charges by roughly 96% to about $4,300. If Narsh
defaults, however, the deal stipulates she must come up with the original
total.</p> <p>States can take a variety of approaches to debt collection. North
Carolina is one of about a dozen that can garnish residents’ income tax refunds,
said <a href="https://www.hfma.org/about-hfma/executive-management/">Richard
Gundling</a>, a senior vice president for the Healthcare Financial Management
Association, a membership organization for finance professionals.</p>
<p>Gundling said state officials have a responsibility to protect taxpayer money
and collect what is owed but that seizing income tax returns can have more
severe consequences for people with lower incomes. “There is a balance that
needs to be struck to be reasonable,” he said.</p> <p>With health care a leading
cause of <a
href="https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#:~:text=Approximately%2016%20million%20people%20(6,debt%20occurs%20across%20demographic%20groups.">personal
debt</a>, unpaid medical bills have become a major political issue in North
Carolina.</p> <p>State lawmakers are considering a bill called the <a
href="https://www.ncleg.gov/Sessions/2023/Bills/Senate/PDF/S321v3.pdf">Medical
Debt De-Weaponization Act</a>, which would curb the ability of debt collectors
to engage in “extraordinary collection” such as foreclosing on a patient’s home
or garnishing wages. But the current version of the bill would not apply to
state-operated health care facilities like the one Mason Narsh went to,
according to Pennington Allison.</p> <p>In a written statement, Stein said he
supports legislative efforts to strengthen consumer protections.</p> <p>“Every
North Carolinian should be able to get the health care they need without being
overwhelmed by debt,” Stein said. He called the bill under consideration “a step
in the right direction.”</p> <p>Narsh said the unexpectedly high amount of the
bill was frustrating, at least in part because for years she struggled to get
Mason more affordable, preventive care in North Carolina. Narsh said she had
difficulty finding services for people with behavioral issues, a shortage
acknowledged in a <a
href="https://www.ncdhhs.gov/news/press-releases/2022/03/23/new-action-plan-aims-helping-children-complex-behavioral-needs-who-come-care-child-welfare">state
report released last year</a>.</p> <p>Multiple times, she said, she has been <a
href="https://www.northcarolinahealthnews.org/2020/10/13/mental-health-patients-fill-the-er-waiting-weeks-for-help/">left
with no option</a> but to take him to a hospital to be evaluated and admitted to
an inpatient mental health facility not suitable for people with complex
needs.</p> <p>Community-based services that allow people to receive treatment at
home can help them avoid the need for psychiatric hospitals in the first place,
Narsh said. Mason’s condition improved after he received <a
href="https://endseclusion.org/2022/06/23/how-proper-support-and-a-service-dog-named-koko-helped-mason/">a
service dog</a> trained to help people with autism, among other community
services, Narsh says.</p> <p>Corye Dunn is the public policy director at <a
href="https://disabilityrightsnc.org/who-we-are/team/corye-dunn/">Disability
Rights North Carolina</a>, a Raleigh-based nonprofit mandated by the federal
government to monitor public facilities and services to protect people with
disabilities from abuse. The irony, she said, is that the same system that’s
ill-equipped to prevent people from falling into crisis can then pursue them
with big bills.</p> <p>“This is bad public policy. This is bad health care,”
Dunn said.</p> Copy HTML

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