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Sun Aug 18, 2019, 07:34 AM

The 'follow-up appointment'


By Eli Saslow

August 17 at 5:41

So far this year, Poplar Bluff Regional Medical Center has filed more than 1,100 lawsuits for unpaid bills in a rural corner of Southeast Missouri, where emergency medical care has become a standoff between hospitals and patients who are both going broke. Unpaid medical bills are the leading cause of personal debt and bankruptcy in the United States according to credit reports, and what’s happening in rural areas such as Butler County is a main reason why. Patients who visit rural emergency rooms in record numbers are defaulting on their bills at higher rates than ever before. Meanwhile, many of the nation’s 2,000 rural hospitals have begun to buckle under bad debt, with more than 100 closing in the past decade and hundreds more on the brink of insolvency as they fight to squeeze whatever money they’re owed from patients who don’t have it.

On one side of the courtroom was a young lawyer representing the hospital, and he carried 19 case files that totaled more than $55,000 in money owed to Poplar Bluff Regional. Three nearby hospitals in Southeast Missouri had already closed for financial reasons in the past few years, leaving Poplar Bluff Regional as the last full-service hospital to care for five rural counties, treating more than 50,000 patients each year. It never turned away patients who needed emergency care, regardless of their ability to pay, and some people without insurance were offered free or discounted treatment. In the past few years, the hospitals’ total cost of uncompensated care had risen from about $60 million to $84 million. Its ownership company Community Health Systems, a struggling conglomerate of more than 100 rural and suburban hospitals, had begun selling off facilities as its stock price tanked from $50 per share in 2015 to less than $3 as the lawyer approached the judge to discuss the first case.

There was one person in town who did believe patients had another choice, and over the past several years Daniel Moore had begun encouraging his clients to make it.

“Don’t pay one cent,” the lawyer had advised dozens of clients. “I don’t care how much the hospital says you owe. Fight them over it.

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