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Blind people still get medical bills they can’t read : Shots


Lucy Greco (left), a web access specialist at the University of California, Berkeley, is blind. She reads most of her documents online, but hires Liza Schlosser-Olroyd as her assistant to sort through her paper mail each month, to make sure Greco doesn’t miss bills or other important correspondence.

Shelby Knowles for KHN


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Shelby Knowles for KHN


Lucy Greco (left), a web access specialist at the University of California, Berkeley, is blind. She reads most of her documents online, but hires Liza Schlosser-Olroyd as her assistant to sort through her paper mail each month, to make sure Greco doesn’t miss bills or other important correspondence.

Shelby Knowles for KHN

A deaf and blind Missouri man says a medical bill he didn’t know existed was sent to collection agencies, sending his home insurance premiums up 11%.

In another case, from California, an insurance company suspended a blind woman’s coverage every year since 2010 after sending printed “verification of benefits” forms to her home without she couldn’t read, she said. The problems continued even after she had an attorney involved.

And yet another insurance company continues to bill a blind woman in Indiana she says she can’t read, even after her complaint with the Civil Rights Office of The Department of Health and Human Services led to corrective actions.

An investigation by KHN found that across the United States, health insurance companies and health care systems are violating disability rights laws by sending medical bills and notices. economically inaccessible. This fact hinders the ability of blind Americans to know what they owe, creating a disability tax on their time and finances.

Important notices are often printed in small, illegible print

More than 7 million Americans 16 years or older with a visual disability, according to the National Federation of the Blind. Disability rights legal experts say making medical information and billing accessible is the right of each of them, protected by various statutes, including The Americans with Disabilities Act, the Affordable Care Act, and the Rehabilitation Act.

But some blind patients tell KHN that the letters they receive may not be readable. Some web pages contain code that is not compatible with screen reader technology that reads text aloud. Some health care systems and insurance companies cannot send documents in braille that some blind people can read by touch. And other visually impaired people can read large print, with the help of glasses or magnifying lenses, but the small print medical bills they receive cannot be read.

Stuart Salvador told KHN via Skype instant message: “I told them that sending me small letters was like hiring a mime to communicate with me from outside my window. The 37-year-old man, who lives in Greene County, Mo., explains that a case of shingles when he was 28 years old left him with only sight and hearing. “I could tell there was something there,” Salvador said, “but I don’t know what I’m going to get out of it.”

Bills are sometimes sent to the collection before the patient knows there is a problem

Salvador says it can take him up to 6 hours to efficiently convert printed medical bills into braille. He said he was repeatedly asked by the hospital systems CoxHealth and Mercy to collect a debt through their automated medical debt referral system after healthcare providers sent him bills that he can’t read. As a result, he said, his home insurer increased his annual premium by 11%, costing him an additional $133.51 and significant trouble.

Nancy Dixon, a spokeswoman for Mercy, said that the health system could not find a bill for Salvador that had been sent to collections on its records within the past 10 years and that it was their policy to facilitate reasonable for any patient to request. CoxHealth did not respond to a request for comment.

Salvador notes that it is a challenge for him and other visually impaired patients who struggle to have access to their billing information. He and other patients told KHN that if they realize a problem exists, communicating with the health system and insurance company can be difficult. Often, they may not even be aware of the problem until it’s too late. And some blind patients don’t keep written documents they can’t see, which can help solve the legal challenge that can arise when overdue payment issues escalate.

Disability rights lawyer Albert Elia, who is blind, said blind people stuck with inaccessible bills often have two options: hope for government action or pursue drag-and-go lawsuits long and expensive. The National Federation of the Blind, as well as the American Council of the Blind, sued and won public settlements regarding inaccessible medical information.

Cycle unreachable – over and over again

Meredith Weaver, senior attorney for Disability Rights Advocates, who helped oversee accessibility implementation for the blind settlement agreement with healthcare giant Kaiser Permanente, says her clients often request to submit documents in Braille or readable with an online screen reader. Then they usually get a document that works for them before the cycle starts again.

“It feels like a mole smack to keep making those demands,” Weaver says.

After the terms of her settlement with Kaiser Permanente expired in 2018, Weaver said, she started getting feedback again from clients who faced similar roadblocks.

Kaiser Permanente spokesman Marc Brown said that the health system conducted an accessibility review after KHN notified them of Weaver’s comment, and he said the company found no “serious errors”. in the platform, we’re not aware of any accessibility issues” that would restrict someone from paying their bills or using our website. (KHN is not affiliated with Kaiser Permanente.)

The websites of many major health insurance companies pose accessibility issues. ‘It’s shocking to conscience’

KHN found accessibility issues on the public websites of Aetna, Anthem Blue Cross and UnitedHealthcare, major insurers whose customers with vision and vision impairments were flagged as having accessibility problems. accessibility. Errors that KHN has identified with the help of a tool created by WebAIMa non-profit web accessibility organization that includes website coding that will make it difficult for visually impaired customers to use screen reader technology to buy health insurance or find in-network doctors .

After learning of KHN’s findings, Andrés J. Gallegos, president of assembly about disabilityAn independent federal agency that advises the White House and Congress, said the panel should look into the matter more deeply.

“It is a shock to the conscience,” he said, noting that the law clearly provides for such accessibility protections.

All three insurers say they work hard to make their services accessible and try to fix members’ problems.

“It’s 2022. Everything is being done electronically; everything is being done online,” said Patrick Molloy, a 29-year-old blind in Bucks County, Penn. “In theory, making websites and payment platforms accessible to visually impaired customers shouldn’t be too difficult. But that’s the world we live in.”

Having an attorney involved does not always solve the problem, say Lucy Greco, a web accessibility expert at the University of California, Berkeley. The 54-year-old blind sought legal help in early 2020 to prevent Anthem Blue Cross from mailing her unreadable print notices — which sometimes resulted in a loss of benefits for her. Unable to read the document requesting to sign and return the document. She now receives some but not all of the email communications she requested and through the company’s online portal.

Greco paid Schlosser-Olroyd $30 and now to help sort out the bills and personal papers that are still mailed. Greco notes that not every blind person can afford such assistance, and even that investment doesn’t always solve the problem.

Shelby Knowles for KHN


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Shelby Knowles for KHN


Greco paid Schlosser-Olroyd $30 and now to help sort out the bills and personal papers that are still mailed. Greco notes that not every blind person can afford such assistance, and even that investment doesn’t always solve the problem.

Shelby Knowles for KHN

Greco hires an assistant to read her letters each month, to help fill in the gaps, but she still misses notices and insurance bills. She recently raised her assistant’s pay to $30 an hour, because Greco wanted to make sure she could keep someone trustworthy with all of her personal information. But not everyone can afford to hire an assistant.

“It makes you feel powerless and makes you feel dependent on people you might not want to feel dependent on,” she says.

‘It’s not easy to enforce these laws’

Even when federal institutions stepped in to fix such problems, the problem persisted. Kate Kelly, 61, of Greenwood, Ind., who is blind and has hearing loss due to multiple sclerosis, was fed up with receiving multiple standard-sized written bills from her insurance company. , Aetna, she filed a complaint with the HHS Office for Civil Rights in early 2020.

But after the office came to an agreement with Aetna to stop sending her invoices in standard-sized text that fall, she said, Aetna soon resumed sending some documents there. The text is too small for her to read. Kelly pushed HHS to reopen her case. This July, records show, the office closed due to what it said was a lack of authority, even though the office was involved in reaching a resolution earlier.

Kelly said her large print invoices are still on hold – one from March just through August – and she is now required to sign for them as they are delivered. When she tried to use the online portal, she said, her screen reader couldn’t read some of the numbers and other information.

“It’s hard to resist; it’s hard to get into the system,” she said. “You see why insurance companies ignore it, because it’s not easy to enforce these laws.”

Alex Kepnes, a spokesman for Aetna, said company employees contacted Kelly following KHN’s inquiry and they “regret the inconvenience this has caused her.” Kelly said she missed Aetna’s call, and although she called the next day and tried to contact the company again, she did not receive a response until November 28. received a complaint form from the company – very small text. print she can’t read.

Meanwhile, Kelly said, her utility company manages to get her big bill every month. And she quickly paid it.

KHN (Kaiser Health News) is a national, editorially and programming independent news agency KFF (Kaiser Family Foundation).

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