Rx for Hard Times : Family Doctors Are Easing Financial Pain for Patients Who Find Themselves Unemployed, Uninsured or Overburdened by Bills

When Cathy and Roger Stollenwerk were overwhelmed with medical bills after the birth of their triplets, Santa Ana pediatrician Dr. Maria Minon was there to help.

“We were really hard-pressed financially then,” Cathy Stollenwerk said. “The medical bills totaled about $150,000.” Because insurance covered only a percentage of the bill, “we had to pay out over $10,000.”

“Dr. Minon helped us enormously. When the children were sick, she gave us free samples of medicine,” said Stollenwerk, whose husband is an aerospace computer systems director. “Sometimes she would take my triplets’ stroller and put bottles of infant formula wherever she could stuff them. When I would bring two babies in to be checked, she would go ahead and check all three without charging us extra.”

Two years later, when the Mission Viejo couple’s fourth child was born and they were still paying off medical expenses, Minon continued to help by deferring the family’s payments and sometimes treating all four children and charging for only two.

But the true strength of Minon’s compassion came when one of the Stollenwerk’s triplets, 4-year-old Kristine, became seriously ill and died of a brain tumor in 1990.

“When Kristine was really sick and I was really worried about my payments for the boys, Dr. Minon’s office staff said, ‘Don’t worry about that right now.’ They knew that would relieve a burden from me just knowing that they would carry that balance for a while.”

Dr. Minon’s charitable approach toward troubled or needy patients is not unique, according to Dr. Richard S. Kammerman, president of the Orange County Medical Assn. It illustrates, he said, how doctors nationwide are assisting their patients, especially amid hard economic times when an increasing number of people find themselves out of work, uninsured or like the Stollenwerks, faced with astronomical medical bills.

“Doctors do this because they have a real love for their patients. You just don’t put them out to pasture because they are out of money,” Kammerman said.

In a recently released study by the American Medical Assn., nearly two-thirds of doctors surveyed nationwide in 1990 said they provided free care to patients or treated them at reduced rates based on their patients’ ability to pay.

Of the 2,100 physicians surveyed by the AMA, 63.8% said they provided charity care to patients. The doctors, who earned on average $164,300 a year before taxes, reported that they spent about 6.6 hours performing free or low-cost care during the week before the survey. General and family-practice physicians were the most likely to give free or reduced-cost care.

Services to Medicare and Medicaid recipients were not included in calculating the number of hours of charity work performed.

“It’s not just a matter that has to do with the recession, although that exacerbates everything,” said Dr. Charles Tupper, the founding dean of UC Davis medical school and past president of the AMA and California Medical Assn. “Doctors have long had a tradition and an ethical concept that one should provide some free or reduced-rate care. Every patient should feel free to discuss fees with their doctor.”

“I find if I have a patient I’ve been taking care of a while and they are out of work, I just say, ‘Pay me what you can,’ ” said Kammerman, who has a family practice in Santa Ana.

“I had one patient I had been seeing for 30 years. She had lost her job and insurance (and her husband was out of work). She had carcinoma on her arm. I took it off. They were more than grateful. Her husband, who was good at woodworking, made me a nice jewelry cabinet. And they made sure I would accept $100. I said, no, but they would not take no for an answer.

“Many doctors will continue to take care of their (out-of-work or financially strapped patients) and will do so without charging them. Their status won’t stay that way forever. Many of these people are skilled professionals. They are responsible people. They eventually will find jobs.”

Ron Robb, a Costa Mesa businessman whose air freight business has suffered during the recession, was worried how he was going to pay his medical bills when it was discovered he had skin cancer on his left ear.

“I had no health insurance. But the carcinoma had to be removed immediately,” said Robb, 49. His plastic surgeon, Dr. Robert Miner, discounted the operation and worked out a plan where Robb could pay about $100 a month.

“I probably discount fees to 15% to 20% of people for one reason or another,” said Miner. “We see a lot of people in the aerospace industry. We know these people are strapped when they are out of work. We do the best we can.”

“Some months our office (which includes six doctors) writes off as much as $30,000 in losses, but we can’t write that off on taxes,” Minon said.

Tupper believes that studies on free care or reduced fees by doctors underestimate the amount performed by doctors. Many doctors, according to Tupper and other medical leaders, don’t bill needy patients for the costs not paid by Medi-Cal or Medicaid. And some doctors will perform quick services to Medi-Cal or Medicaid patients without billing the government because they believe that the reimbursements barely cover the cost of doing the paperwork.

“Many have taken Medi-Cal patients for years and never bothered to bill because it costs them more to bill Medi-Cal than what Medi-Cal pays. So they just write it off (as a loss),” said Miner.

“All doctors who treat Medi-Cal patients are subsidizing the system or giving the patients discounts every time they see a patient,” Tupper said. “Indeed, many doctors in California receive less compensation from Medi-Cal than it costs to run their office. And so in essence, they actually lose some money on each Medi-Cal patient.

“It’s very unusual to find a doctor who will say he won’t take Medi-Cal patients at all. We do see doctors who say they don’t want to accept any new Medi-Cal patients, but they certainly will continue taking care of those who have been their patients.”

Ellen Severoni, president of California Health Decisions, a nonprofit health-care advocacy group, said the problem cannot be solved simply by physicians’ charity.

“It really does help in many ways. I don’t want to suggest that they couldn’t do more. But the problem is when when you have about 40 million Americans without insurance, how is that charity work going to make a difference for those uninsured?”

This lack of affordable health insurance “is a disaster waiting to happen,” asserted Dr. Richard E. Katz, who has a family practice in Garden Grove. “What you are going to see is middle-class Americans who are suddenly without health insurance, trying to meet their medical payments and go bankrupt.”

“One of the biggest problems now in Orange County having to do with receiving free care is that we really don’t have a county hospital,” Miner said. “It is probably more difficult than in the rest of the counties in California to get indigent care because there is no county system. We would like the county to set up a string of clinics where you can go in and get the colds and all this small stuff taken care of for one-tenth of the price it would be if you had to go to the emergency room where the standard of care and equipment is so much higher.”

In addition, the California Medical Assn. is pushing for the adoption of an Affordable Basic Care plan that would ensure health insurance is available to the working uninsured, Tupper said.

UCLA’s School of Public Health has conducted recent studies showing that more than one out of every five Californians are without health insurance, either public or private, Tupper said. These 6 million Californians, 75% of whom are working people or are dependents of workers, “rely on public hospitals or charity care to get their most basic services,” he said.

“These uninsured people flood hospital emergency rooms--the most expensive place to take care of them. If they would have been seen at the doctor’s office three weeks earlier it would have been a bad cold or bronchitis, instead of the pneumonia they show up with in the emergency room.”

The AMA views the issue of doctors providing charity care or reduced-fee care with “continuing importance,” Tupper said. Sure, there are doctors who grumble about it or refuse to do it, he acknowledged.

“But the remarkable thing is how few they are and how quickly they are stepped on by their colleagues. The few times I’ve run into it, it is usually from somebody who is in the higher levels of income who is complaining,” Tupper said.

“Many doctors, like Dr. Minon, are helping their patients,” Kammerman said. “They are doing it out of the goodness of their hearts.”