Karen* was 26 when her partner drove her to an ER in Boston the morning after she was sexually assaulted. She opted for a pregnancy test, pre-exposure prophylaxis anti-HIV treatment, and an IV. She assumed her insurance from her job as a certified rape crisis counselor would cover the costs.
But four months later, she received a bill from the hospital. It contained a breakdown of what her insurance covered and what she owed — and it exceeded $1,200.
Karen is not the first sexual assault survivor to get surprised with exorbitant fees. Despite the law’s intentions of offsetting medical expenses that should not have to be paid by the sexual assault survivor (and it’s not taxpayer dollars covering the costs, but rather funds from crime victim compensation programs), some hospitals are extraneously billing the patients for tests and treatments, further contributing to their distress.
In a recent study published in the American Journal of Public Health, researchers analyzed the insurance policies of 1,355 female rape survivors between the ages of 16 and 61. They found that nearly all of them paid healthcare costs — an average of about $950 — for crimes committed against them. The study found that while insurance typically covers 86% of the $6,737 average cost of rape, including for items like a rape kit — an involved exam that collects forensic evidence for a tailored treatment program or to support court proceedings should you wish to prosecute — survivors are generally left to cover the remaining amount out of pocket. Between antibiotics, sleep aids, anti-anxiety medications, emergency contraceptives, and other related treatments, the study showed some survivors accrued up to $8,900 in charges in the first month alone.
The cost is even more disheartening given that protection clauses in the law like the Violence Against Women Act (VAWA) were established to prevent hospitals and healthcare providers from billing survivors after their assault. Still, many providers in the country have figured out how to tack on extra fees, Michelle Katz, a licensed practical nurse, health insurance advocate, and author of Healthcare for Less, 101 Health Insurance Tips, and Healthcare Made Easy, tells Teen Vogue. She says that depending on the facility, physicians often charge a professional component associated with their expert reading of the diagnostic or lab work, a site fee for the cost of the room and equipment, and a technical fee for the kit itself. This begs the question: Are hospitals unnecessarily billing survivors?
When Karen first provided her insurance information to the hospital immediately after the attack, she said she was in no state to ask about any hidden fees or what portion of the treatment her insurance would actually cover. By the time she was mentally prepared to pay the balance seven months after the assault, the hospital had already contacted a collections agency. They then settled on a payment plan, where she ended up paying in $10-a-month increments over the course of two years.
Facilities across each state use different processes for paying for forensic materials, Jennifer Pierce-Weeks, a registered nurse who is also a sexual assault nurse examiner and Chief Operations Officer of The International Association of Forensic Nurses. Emergency rooms are required to see patients without any expectation of payment, making it difficult to gauge if and how much survivors will end up paying.
Katz says the laws state that in the aftermath of sexual assault, a survivor should not be sent a bill for “critical ER services that place an important role in helping law enforcement make an arrest and work to achieve justice for the survivor.” But that’s not always the case. She says there’s “a negotiated rate between [hospitals and insurance companies] and in the end, whatever the insurance does not cover, the hospital might try to ‘balance bill,’ — when a provider bills you for the difference between the provider’s charge and the allowed amount — which is actually illegal, but no one really complains.”
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