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In fact, the hospital brings in so much money that all of this wage garnishment turns out to be a minor item on its balance sheet. Totaling up all the money the hospital seized from patients’ wages last year, according to court records, shows that wage garnishment brought in just half of 1 percent of its revenues.

Other hospitals in Missouri have found ways to avoid suing low-income patients. BJC Healthcare, a nonprofit, operates a chain of 12 hospitals, including Barnes-Jewish Hospital in St. Louis, the largest in the state. In 2013, the BJC hospital chain filed just 26 lawsuits. Unlike Heartland, BJC automatically slices 25 percent off its standard rates for uninsured patients and never includes interest on payment plans, said June Fowler, BJC’s spokeswoman.

By comparison, Heartland hospital’s debt collection arm filed over 2,200 lawsuits in Missouri courts in 2013. “It’s not fair to those who are paying to not be aggressive with those who have the ability and aren’t paying,” Wagner says.

She says the hospital does everything it can to fulfill its mission as a nonprofit, charitable institution. Patients are offered multiple opportunities to qualify for financial assistance and avoid the possibility of legal action, she says. It would be better for everyone, Wagner says, “if we attempt to work on things before it gets to this level.”

In recent years, the hospital has made its charity care policy more generous. Heartland’s policies state that anyone making less than three times the poverty line can qualify to be billed at a reduced rate, similar to what an insurance company pays, and then get that amount cut in half. If they make less than twice the poverty line, the entire bill is forgiven.

The hospital makes every effort to let patients know that they may qualify for help, Wagner says. “Financial counselors are available if a patient asks for that.” But if patients don’t utilize those resources, she says, the hospital must take action.

“No one goes into this with the goal or the desire to ruin someone’s life,” Wagner says. “But at the same time, the services were rendered, and we have to figure out how to get them paid for.”

Asked why the hospital sues more patients than any other in the state, Wagner said, “I don’t know.”

Last year, about 8,700 Heartland patients had their bills cut or zeroed out, according to data provided by Heartland. About half of those were uninsured, while the rest were spared full payment of deductibles or other obligations not covered by their insurance.

But uninsured patients like the Heries who don’t receive charity care — either because they were turned down or never applied — are billed at Heartland’s standard rates, the sticker price that insurers never pay. In 2013, more than two-thirds of the accounts the hospital’s debt collection division handled involved uninsured patients, according to data provided by Heartland.
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