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AZ Prepper
12-01-2009, 10:32 AM
Get Out of Debt, Stay Out of Debt
by: Darlene Campbell
http://www.backwoodshome.com/articles2/campbell67.html


Decades ago it was advised of young high school graduates to deposit a set amount of money into the bank each month, and when they retired they would be millionaires. Unfortunately, that philosophy fell by the wayside after World War II. Today it is not unusual for young graduates to receive credit card applications by mail starting them on the road to indebtedness, not the road to wealth.

If you are in debt now, you should be working to clear all indebtedness during the next year. We did it, and you can, too. We paid off credit card debt and doctor bills. We paid off the car and made double payments on the mortgage principle of our home with the intent of paying that off, too. But as the future began to look uncertain, we changed plans and sold our mortgaged home and obtained enough money from the equity to pay cash for a smaller home. Both my husband and I have even quit our jobs since having no debt means we need less income. We are not old enough for retirement and do not collect disability, retirement income, or welfare. Instead we have simply freed ourselves of debt and can now pursue other interests and earn sufficient money doing practically nothing.

We have enough money to eat, pay utilities, and put gas in two vehicles. I freeze a lot of food, and what we do not grow we purchase on sale. Most of our income comes from selling at flea markets and over the Internet.

Knowing how much you owe and how much you earn is not going to get you out of debt. You must learn to do with less, stop buying on credit, downsize what you already own, and eventually you will be debt free. Sounds easy enough, but most people find this is the most difficult part of getting out of debt. They don’t want to stop spending. Most people struggle to have more, not less.

Where do you spend?

It is necessary to organize your financial records, then develop a plan for paying off creditors. Gather the following records: your most recent pay stub, most recent bank statement, your checkbook, and all current credit card bills, medical bills, utility bills, insurance premiums, children’s allowance, pet care, installment loans, newspaper subscription, cable TV, transportation, etc.

With these items in front of you, enter your income on the top line of a sheet of paper. This is your worksheet. List every known monthly expense, from the kids’ allowance to the mortgage payment, and add it up with a calculator. When you finish you will see how much you earn and where the bulk of your money is spent. On the same worksheet, list out-of-pocket or miscellaneous expenses—all those little expenses down to the smallest item such as a coffee break, hamburger, purchase of a key ring, or cigarette lighter. Pay close attention to these small expenditures because they add up to a significant sum on a monthly basis, and are almost always wasteful.

If you spend a lot unnecessarily, or are an impulse buyer, you probably can’t come up with a figure for miscellaneous out-of-pocket expenses. In order to find out what you are spending unnecessarily, begin a journal of where your pocket money goes. When you have to take time to record each purchase, you will become less impulsive. Carry a small, inexpensive pocket notebook and list your spending as it occurs so you won’t forget. If you are shopping at a mall and stop for lunch, enter everything you purchased while you are eating, including your meal. If you buy a magazine, make the entry in your journal when you get back into your car. Another way to keep track of such expenditures is to save the cash register receipts and enter them all into the journal at the end of the day. Maintain this journal for one week, then multiply the sum total by four to find the amount spent in one month. If you doubt this total, continue the journal for the entire month. Enter this amount on the sheet of paper with your other expenses. Call this your out-of-pocket or miscellaneous expenses.

Categorize your monthly expenses by listing similar expenses in the same category on the worksheet. You may want to list monthly living expenses such as mortgage or rent, utilities, and gasoline separate from irregular expenses incurred on an annual or semiannual basis like insurance, taxes, and auto licenses. There are flexible expenses that are necessary but can be reduced, like food and clothing, over the counter drugs, toiletries, and out of pocket expense. Finally, there are questionable expenses that are wasteful and can be easily eliminated.

Now you can work on eliminating those expenses that are unnecessary. Can you reduce the number of trips to the hairdresser? I have cut my husband’s hair for the last 35 years, and we save a bundle.

No more credit card

If you are charging $100 a month on credit cards, you must cut back at least $100 a month. By cutting back $100 a month you can quit using your credit card which is the beginning of paying it off. Take time to read your monthly credit card statement; it can be very enlightening. What interest do you pay? How is it figured? Is it two cycle billing? Most major department stores charge in the range of 20-21% interest, while bank credit cards charge from 5-9% as an attractive come-on, then raise the rate in six months to around 17%.
To be credit card free, take the total you owe on credit cards and divide it by the number of months in which you wish to be debt free. The answer is the amount of cash you must pay every month, plus a little more to cover interest, to free yourself of that debt within the desired time. Paying on several cards each month means you are paying interest to multiple creditors. If a new credit card offers a low interest rate to entice you to pay off your other cards, take advantage of it, but plan to pay off this new card at the introductory low interest rate before the new, higher rate comes into effect.

Pay the most you can possibly afford and think how you are paying so much a month for goods or services that you purchased a year ago and may no longer use. If you had the extra cash each month you would feel so free. You must be strict with yourself and make the commitment to pay off the debt within a specified time. It means you will now buy less, make do, and recycle everything possible to come up with the monthly payment. Your reward is watching the balance drop rapidly.

But this only works if you stop using the card! The best way to do this is to put it in a safe place where you are not tempted to use it. Do not carry a credit card on your person. After you pay off the card, notify your creditor that you are destroying the card and want to cancel your account. This way you will not be subject to annual fees later, or tempted into using it.

When you have consolidated all your credit card debt into one card with a lower interest rate, you will probably wonder how you are going to meet such a large payment each month until it is paid off. It scared me, too. We consolidated our two cards into one four-digit debt. With only six months before the low introductory rate changed to a much higher rate, we divided the six into the total and came up with $350 a month. Our payment was high, but we persevered until it was paid off.

Found money

Finding $350 a month was rough. It’s more than some people pay in mortgage payments. We made the payment every month and cut expenses everywhere else by pulling in our belts for a few months. I relied heavily on “found money,” small amounts of money that I managed to save or set aside.

Begin saving all your loose change. John taught me this years ago by doing it diligently himself from the beginning of our marriage. I never did it until we had to have the extra $350 a month. I put pennies in a tall bottle, nickels and dimes in a cream pitcher, and quarters in a face cream jar hidden out of sight. I discovered the bottle holds over $10 in pennies, the face cream jar holds $20 in quarters, and the cream pitcher holds $30 in nickels and dimes. Get yourself some free coin rolls at the local bank. Put the paper rolls in a security box, and once every two or three months roll all your coins, or as many as you need to free space in the containers, and place the rolled coins in the security box.

You must work to make your found money grow, so every time you come home from shopping, separate the coins. When you pay for an item, use only bills to make sure you are given change in return which you can save. If you feel a little rich, buy some coins; ask the cashier to give you a dollar or two in quarters. You will be amazed at how you never miss this change, yet it seems to grow by the month. If you are diligent, you should be able to save several hundred dollars a year in this manner, which you keep in the security box for emergencies or deposit in a special account.

You can gain found money in your checking account by rounding up the checks you write to the nearest dollar in the check register. You don’t want to lose track of the actual amount of the check so write this amount in parenthesis next to it. This not only makes your check book easy to figure, it always leaves a little extra in reserve.

Another method of having found money in the checking account is to draw a line across the page after you balance your account. The next deposit becomes the new balance and checks are written only on that balance. If there is a balance in the account at the end of the month, that too gets a line drawn under it to signify that you are beginning a new cycle and will write checks only on the next deposit. Each month leaves a little more in reserve; it might be only 89 cents, or it might be $12.89. This amount becomes hidden and is seen only when the monthly bank statement arrives. Check your statement balance against your cycle balance and the difference is found money in your account. It will add up to a considerable sum if untouched. It will also help prevent you from overdrawing, which can be very costly.

Found money also includes the coupons you clip from newspapers and use as cash at the supermarket. Get them organized and use them. Some stores will double the face value of the coupon up to a certain amount, so if you happen to find the item on sale and use a coupon to purchase it, you may get the item free.

It’s a good idea to get your family around the table and talk about cutting expenses. Each family member will be affected differently by financial downsizing. Younger children won’t understand, so it’s best to explain to them in simple terms to prevent any anxieties. Older children may act reluctant as they are worried about what their peers will say. Ask their advice along the way and make suggestions for their help like taking on a part-time job after school. This could free up some allowance money. Most older children want to take responsibility for their own spending, so you may inform them that the money they earn should be used wisely such as paying for their school lunches, their clothes and activities. They will appreciate being treated as an adult in this matter.

Establish some goals

As you list your expenses on the worksheet, set up a column with a date you expect to pay off each debt. You should have short-term and long-term goals. Short-term goals could be paying off doctor bills, credit cards, and loans. Long-term could be paying off the automobile and the mortgage. Your short-term goals tell you which creditors will be paid off quickly. A good way to establish priorities among your creditors is to use the balance due each one as your guide. Make the smallest bill your main priority, and the largest bill your last priority. By this I mean to pay off the smallest debt first so that once it is paid off in its entirety you can apply the amount you would normally pay to it to the next priority on your list.

If your worksheet shows that you are spending more than you are receiving in income and there are a lot of creditors bothering you, don’t be alarmed. Simply pick up the telephone and call those creditors and explain that you are working out a financial plan and will be making regular payments until each bill is paid in full. Creditors are very easy to work with if you let them know that you are making an effort to pay them. Take, for example, doctor bills; if you talk to the bookkeeper or the person responsible for sending out the statements each month that you can afford only $10 a month on a $700 bill, it usually will be accepted. By law you cannot be taken to court if you are making an honest effort to pay the account, and make regular payments. Once you get some of the bills paid off you can increase your monthly payment to the doctor from $10 to $20, $40, or more.

Keep the worksheet where you can refer to it often. Keep a copy of it wherever you sit to pay the bills. As you pay off a creditor in full, mark it on your worksheet. Now apply the amount you were paying to that creditor to the next priority on your worksheet. Just because you have a set amount due each month on a particular bill does not limit the amount you can pay on it. Once one bill is paid off in full, you will have that extra monthly cash to apply on other bills. Apply all of it to one bill to pay that debt faster; do not spread it around on all the bills. When the second debt is paid off, you now apply the combined amount of the previous two bills to the third bill, plus the normal payment to eliminate it quickly. If you have a date marked on the worksheet for paying off each creditor, you may find as you progress that you can beat those deadlines as you apply the additional cash to each one of them.

You should have a place where you can work undisturbed while figuring and paying bills each month. If you have a desk with a drawer that can be used for the purpose, very good, but if you only have the dining room table then get a cardboard box to set up a file system for maintaining records of each bill you pay, for saving pay check stubs, bank statements, income tax records.

While you struggle to pay off your debt and to live with less, consider ways to eliminate spending so you can live within your means. If you are accustomed to buying yourself and your children soft drinks every time you go to town, and each drink is in the neighborhood of a dollar, you can save those dollars by waiting until you get home and serving powdered drink mixes or canned juice. Buy packages of generic soft drinks and serve them chilled at home or make iced tea using loose tea leaves.

I take along a large thermos of lemonade when we take a trip to town. Often I sit with the children in the car at a shopping mall parking lot and eat sandwiches and cookies. Stopping for a hamburger is not on the agenda, and if we do stop for hamburgers at McDonalds it is for a special treat such as a birthday celebration. Consider taking along an ice chest packed with your meal, which will double as a container to carry home your perishable purchases which includes not only groceries, but animal vaccines that lose potency if not kept cool. Freeze bottles of water to keep it cold, or recycle those ice packs that are packed with vaccines when you order by mail. Trips to the city are still all day adventures walking the malls and looking into store windows (window shopping is free).

Special accounts

Who ever said a person should have only one checking or savings account? If you are like me, this does not manage your money efficiently enough to have a sum set aside for land taxes, auto insurance, fill the propane tank, eye glasses, or school clothes. We always mean to set money aside, but somehow it gets spent, and when the time comes to pay for those expected needs, we just don’t have the money unless we struggle and juggle the budget. What to do? Open a special account.

Special accounts can be either checking or savings. Locate an account that is free. That means free checks with no monthly service charge, or a savings account that does not charge a penalty for withdrawal or low balance. Some banks even pay interest on checking accounts these days, so shop around and ask questions. Make a few calls; you don’t have to open the special account at your present bank.

Make regular deposits into this account, and never, never draw money out or write a check against the account unless it is for that special need. For example, suppose your land tax is $400 a year and you have opened the account to save for that need. Divide that amount by 12 months and you get $33.33. If you deposit $34 monthly into the special account, you never have to worry about where the money is coming from to pay your land tax.

You may not have an extra $34 while trying to pay off your other debts. What do you do in that case? Discover some source of income that can be regularly deposited into the special account. Deposit the egg money, the income tax return, money made from baby-sitting, your saved change, money from the sale of livestock, hay, etc. Raise something special like rabbits. If the income is directed toward the special account, you will find that $400 a year is easy to save, and you may even end up with closer to $600, so that you can purchase something special or needful like a set of tires for the truck.

Do not underestimate a special account. It is the modern version of Grandma’s sugar bowl savings, but less easily dipped into or spent unwisely since it requires a banking transaction.

The final leap. You’ve made it; you’ve finally paid off all your debts and now have freed up your cash. Where do you go from here. It’s time to look at the long-term goals. Mortgages can be paid off rapidly if you pay an additional $100 or $200 a month on the principle. Be sure to note on your payment that it is to be credited toward the principle, or it may go into your escrow account. When we began making large principle payments we learned that an additional $100 a month would shave off 120 months from the payoff date, and save us $21,436 in interest. It was at this point that we made the decision not to pay off our mortgaged house, but to sell it and pay cash for a smaller one with the equity.
Whatever you do, don’t get trapped into debt again. We got out from under those bills and you can too.

Nauvoo2002
03-25-2010, 08:14 PM
Get Out of Debt, Stay Out of Debt
by: Darlene Campbell
http://www.backwoodshome.com/articles2/campbell67.html


If your worksheet shows that you are spending more than you are receiving in income and there are a lot of creditors bothering you, don’t be alarmed. Simply pick up the telephone and call those creditors and explain that you are working out a financial plan and will be making regular payments until each bill is paid in full. Creditors are very easy to work with if you let them know that you are making an effort to pay them. Take, for example, doctor bills; if you talk to the bookkeeper or the person responsible for sending out the statements each month that you can afford only $10 a month on a $700 bill, it usually will be accepted. By law you cannot be taken to court if you are making an honest effort to pay the account, and make regular payments. Once you get some of the bills paid off you can increase your monthly payment to the doctor from $10 to $20, $40, or more.




This used to be true, but unfortunately -- it is no longer the case. In an ever increasing number of cases now, doctors, dentists, hospitals and other health care providers are selling the medical debt to for-profit banking institutions and credit card companies. Oftentimes AFTER payment plans are in place and being honored, and without the knowledge or consent of the person who is working hard to pay off the medical debt.


This article from Business Week magazine explains what is happening more and more today in the world of medical debt:


Fresh Pain for the Uninsured: Citigroup, Others Target The Sick, Injured
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As doctors and hospitals turn to GE, Citigroup, and smaller rivals to finance patient care,
the sick pay much more

by Brian Grow and Robert Berner

In a lucrative new form of fiscal alchemy, a growing number of hospitals, working with a range of financial companies, are squeezing revenue from patients with little or no health insurance. April Dial's dealings with Hot Spring County Medical Center in Malvern, Ark., illustrate how the transformation of medical bills into consumer debt means quicker cash for medical providers but tougher times for many patients of modest means.

Dial, a 23-year-old truck-stop waitress who earns $17,000 a year plus tips, suffers from Type 1 diabetes. Sudden drops in her blood sugar level have sent her to the emergency room four times in the past three years. In September she spent three days at Hot Spring, including two in intensive care, fighting complications from her ailment. The bills came to more than $14,000. Dial's job offers no health insurance.

Until recently her mother, Carolyn, who waits tables at the same roadside diner, sent Hot Spring $100 a month under the nonprofit hospital's longstanding zero-interest payment plan. Dial says she couldn't make payments herself because she spends more than $150 a month for other treatment and insulin.

Sophisticated Help

In October she learned that Hot Spring had transferred her account to a company called CompleteCare, one of the many small firms fueling the little-known medical debt revolution. Enticed by the enormous potential market of uninsured and poorly insured patients, financial giants such as General Electric (GE), U.S. Bancorp (USB), Capital One (COF), and Citigroup (C) are rapidly expanding in the field or joining the fray for the first time. CompleteCare informed Dial that under the complicated terms of her newly financed debt, her minimum monthly payment had shot up more than fourfold, to $455. Dial says she doesn't have anywhere close to that amount left over after rent, food, and other doctor visits: "Every extra dime I have goes to paying medical bills."

Collecting from "self-pay" patients like Dial has long been the bane of medical administrators. When they don't get paid immediately, hospitals typically recover around 10¢ on the dollar owed, even when they hire collection specialists. So hospitals and clinics are bringing in more sophisticated help. They are transferring patient accounts wholesale to finance experts, banks, credit-card companies, and even private equity firms. Many of these third parties use credit scores and risk-analysis software to price the debt and impose interest rates as high as 27% on past-due bills.

Among hospitals, nonprofits like Hot Spring County Medical Center are more likely than for-profit rivals to join forces with finance firms. Fewer nonprofits have effective in-house collection departments, and in many regions a higher proportion of patients at nonprofits lack insurance. "Hospitals can't just be an interest-free finance vehicle," says Todd Cole, director of patient accounting at TriHealth, a $2 billion pair of nonprofit hospitals in Cincinnati. "The world of $5 sent to the hospital and they will never send me to collections, never sue me—that world has gone away," he adds. TriHealth sells patient accounts at a steep discount to firms that specialize in collecting delinquent consumer debt. "Hospitals need their cash," Cole says. "It is the lifeblood that supports the doctors, the nurses."

Crafty Cards

For hospitals and outside firms to obtain that cash, someone has to pay. The people most likely to feel the pain are often those least able to afford it—patients who lack private insurance but who are not poor enough to qualify for charity care or government benefit programs. The pool of self-pay patients is mammoth: Some are among the nation's 47 million uninsured; others are among the 16 million whose plans offer scant coverage or have deductibles as high as $10,000. Several recent studies have shown that medical debt is a leading cause of personal bankruptcy filings.

A host of nimble firms like Complete*Care in North Little Rock, Ark., began exploring this terrain years ago. Bigger players have jumped in more recently, although the market remains fragmented and reliable market share information isn't available. U.S. Bank, a U.S. Bancorp unit, finances about $2 million in patient debt per month through a medical-benefit firm, charging most customers annual interest of 13.5%, and as much as 24% on late bills. General Electric's powerful financial arm markets its CareCredit card to dentists, plastic surgeons, and some hospitals, with loan volume expected to hit $5 billion this year, up 40% from 2006. Citigroup and Capital One now offer similar cards. "Everybody is saying [medical finance] is the next horizon—whether it is lines of credit or credit cards," says June St. John, a senior vice-president at Wachovia (WB), which is exploring the business. Whetting all these appetites is the $250 billion consumers pay in medical expenses out of their pockets, an amount that doesn't include insurance premiums. That's an estimate for 2005 from the consulting firm McKinsey & Co. The figure could hit $420 billion by 2015.

BusinessWeek's investigation of the fast-expanding *medical-finance field has uncovered hazards, however. Many patients say they don't realize their debts are being shifted to such interest-charging middlemen as GE Money Bank, the unit that issues the Care*Credit card. That's what happened to Alice Diltz when she visited Hillside Dental Care in Queens, N.Y., in October, 2005. Diltz, a 68-year-old part-time hospital aide, needed implants for two rotting teeth and three missing ones. The Hillside staff told her she would have to pay $7,450. But her dental insurance, provided by her retiree husband's policy, offered only $200 for extractions. Diltz paid $250 from her pocket and signed up for what she says she thought was an installment plan directly with the clinic. In fact, she signed an application for Care*Credit, which was labeled as such, but in small print. Diltz says neither Hillside dentist Ben Mokhtar nor his staff mentioned a credit card.

While having her teeth pulled, Diltz began to bleed heavily. She got scared and left the dental office after the extractions. Four days later she canceled the implants, assuming her dealings with Hillside were over. But several weeks later she received a bill from CareCredit for $7,000. Hillside had transferred that amount to the credit-card company, which in turn paid the clinic about $6,300 up front. Diltz says she called CareCredit to dispute the charge, but bills kept arriving. Several weeks later, she says she called again and objected in writing. But GE told her she had missed a 60-day deadline and couldn't reverse the charge.
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Outside Scrutiny

The GE card typically comes with an introductory 0% interest rate, but after Diltz didn't make her initial payment, the rate leapt to 26.99% on an annual basis. In August, 2006, GE Money Bank sued her in state court in Queens. With the help of the nonprofit Elder Law Clinic at St. John's University School of Law, she contested the debt, which grew to $10,175. "It was horrible to get those letters from GE," says Diltz. She and her husband live on $18,000 a year from her part-time job and social security benefits. "It was so stressful from day to day."

A GE spokeswoman, Cristy F. Williams, said in an e-mail that the vast majority of CareCredit's 6 million customers are satisfied. In the Diltz case, "we provided her with a dispute form and discussed the dispute process with her a number of times," Williams added. "She did not respond for several months." However, on Nov. 12, after BusinessWeek inquired about the case, GE said it had changed its stance. Williams said the company would erase Diltz's debt and remove any reference to it on her credit report. The spokeswoman said GE had begun to reassess Diltz's account on its own initiative. "We could have and should have been more sensitive to Ms. Diltz," she said.

Diltz's lawyer, Gina Calabrese, said she was skeptical that GE would have reversed itself absent a reporter's asking questions. "They knew about all these facts almost a year ago," the attorney said. "Imagine what is happening to all the unrepresented people who have valid cases." Mokhtar and his staff declined to comment.

About-Face

In another instance, BusinessWeek's questions prompted GE to acknowledge that a medical clinic had pressured uninsured patients into using the CareCredit card. Dawn Shelly, 33, visited the Christie Clinic in Urbana, Ill., in late 2003 for a sinus infection. She told a staff member she couldn't afford to pay the $90 bill in cash. At the time she earned $7.50 an hour as a part-time school bus monitor; the job didn't offer insurance. The clinic, Shelly says, told her the only option was to apply for CareCredit. She says she thought she was signing up for a program similar to insurance, under which she would owe only a modest co-payment. "I never would have signed up if I knew it was really a credit card," she says.

Her CareCredit balance mounted with several additional visits to the clinic and a local emergency room, where she was treated by a clinic doctor. Unable to keep up with payments, Shelly, now unemployed, owes $3,485 to CareCredit, according to an Oct. 24 collection letter. Much of that balance comes from late fees and finance charges of 26.99%.

Until recently, the Christie Clinic's Web site stated that patients who couldn't pay in full "must apply for Care*Credit." After BusinessWeek asked GE about the clinic's policy, the company said it would correct the situation. "We are instructing the provider to remove the language and change their policy for soliciting applicants for CareCredit," said GE's Williams. She added that GE would drop all fees and finance charges from Shelly's bill. The company also will try to resolve the concerns of any other patients who were required to use CareCredit, she said.

In early November, the Christie Clinic removed all references to payment policies from its Web site. Anni McClellan, the clinic's director of financial services, said it is reviewing the policies. Christie discusses a variety of payment options with patients, she said. "There are so many specific circumstances surrounding each patient's financial conditions."

The Fine Print

Early experiments with financing self-pay medical bills began in the 1980s, when consumer-credit executives saw an opportunity in soaring debt levels and inefficient hospital billing practices. Most patients think that "your doctor will probably see you again and the hospital will not turn you away if you don't pay the bill," says Richard L. Clarke, chief executive of the Healthcare Financial Management Assn., an industry group. "On the other hand, with the credit card or a loan [from] the bank, people will be more concerned about defaulting because that is almost certain to cut them off from credit."

That's precisely the strategy that drives CompleteCare, the small Arkansas firm, which says it works with 40 hospitals and more than 400 physician practices across the country. Addressing potential health-industry clients, the company boasts on its Web site that it "pioneered the concept that patients become consumers the minute they walk out of your facility." April Dial, the diabetic waitress, says she didn't realize she had been transformed in this manner until weeks after leaving Hot Spring Medical Center in September.

Dial says a hospital financial counselor told her mother by phone in October that Hot Spring had discounted her debt by roughly 50%, to $7,300, before transferring the balance to CompleteCare under a contract the company signed with the hospital in June. Although she was surprised to learn about the transfer, Dial in fact had signed an admission-consent form at Hot Spring that included a small-print section authorizing the hospital to turn over her account. In contrast to the hospital's former zero-interest payment plan, Complete*Care charged Dial 5.75% interest on the first $2,500 of her balance, with a minimum monthly payment of 10% of the outstanding debt. CompleteCare initially applied the 10% rate to only $4,545 of the total bill, and required that Dial pay $455 a month.

After BusinessWeek contacted CompleteCare in early November, and Dial asked to have her case reviewed, the company said it would lower her minimum payment to $125, interest-free. CompleteCare President Steven C. Owen said the company changed the terms because Dial's "situation is so dire in terms of the balance owed. Our whole philosophy is trying to make it easy to pay."<!-- / message --><!-- sig -->
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Dubious "Help"

Hot Spring's chief financial officer, Sheila Williams, said the hospital switched to Complete*Care hoping that patients "would pay a little faster if they were charged interest. It would become like a credit card." CompleteCare ran an ad in a local newspaper this summer to announce the change. But in recent weeks, she said, the hospital has reconsidered the arrangement in response to a complaint from a patient other than Dial. Hot Spring decided that effective Nov. 9, patients using CompleteCare would no longer be charged interest. "We just rethought it and decided that maybe it is not in the best interest of our patients," the hospital executive said.

Dubious innovations in medical financing are beginning to gain attention in Washington. Lawmakers and the IRS are investigating more broadly whether nonprofit hospitals provide sufficient free care to the uninsured to warrant more than $50 billion in annual tax breaks. Senator Charles Grassley (R-Iowa), the ranking Republican on the Senate Finance Committee, says some new financing arrangements appear to undermine the justification for tax-exempt status enjoyed by more than half of the country's 5,700 hospitals. "I'm very troubled by what we're seeing with some nonprofit hospitals' cozying up to banks, debt buyers, and credit-card companies over patients' medical bills," Grassley said in a statement responding to questions from BusinessWeek. The American Hospital Assn. said it hasn't studied the financing in question, but the trade group has repeatedly asserted that nonprofits provide ample community service to justify their tax benefits.

One of the leaders in this new field, HELP Financial, says that it merely makes the health-care business run more smoothly. The privately held Plymouth (Mich.) firm, whose initials stand for Hospital Expense Loan Program, says it has financed close to $300 million in medical bills at 100 hospitals nationwide. HELP purchases the debt at a discount and then charges patients interest of 10% to 18% over periods of one to five years. "The motivation for the hospital is really to keep them in the health-care business and out of the banking business," says HELP Vice-President Steve Posa.

Mia and Jase Redick reluctantly became HELP customers earlier this year and then discovered that they owed the company a hefty 14.5% on a bill of $6,293. In January, Mia, 36, had been rushed to Satilla Regional Medical Center in Waycross, Ga., after suffering a mild stroke. Tests revealed a small hole in her heart, a congenital defect that eventually required surgery. Mia, a pharmacy worker, and Jase, a job trainer for the state of Georgia, earn a combined $90,000 a year and have two small children. They lost state-provided insurance when Jase became an independent contractor in 2005, and had chosen to save money by going without coverage at the time Mia had the stroke. The couple assumed they would be able to pay the $6,293 tab for emergency care and tests in monthly interest-free installments. For years that's how Mia's family, Waycross natives, had used Satilla's in-house payment program. "It's what we always did," she says.

But on the winter morning when Mia arrived at the emergency room, a hospital administrator informed the Redicks that Satilla no longer offered its old payment plan. Jase says he was distraught and refused to discuss money that day. At a meeting the next week, the Redicks say they were told they had two options: retire the debt within 90 days and receive a 15% discount, or finance through HELP. With insufficient cash in the bank, the Redicks chose HELP. Distracted by Mia's condition, they didn't ask about having to pay interest. The bill arrived in March with the 14.5% rate, which translates into a monthly payment of $148. On top of $24,000 they owe to another hospital where Mia had surgery in February, "the overall cost of the debt is a lot to handle," says Jase.

Discounted Debt

Officials at Satilla say they brought in HELP in 2002 to reduce bad debt levels among the large population of uninsured patients in the hospital's rural south Georgia region. Through October, HELP had acquired $718,000 in Satilla debts. HELP pays 92¢ per dollar owed to the hospital. Satilla could trim the firm's 14.5% interest rate by selling debts at a greater discount but has chosen not to, according to Brenda Williamson, the hospital's accounts-receivable supervisor.

Barbara G. Albert, Satilla's patient financial services manager, stressed that the Redicks turned down Satilla's discounted 90-day payment plan.

With more uninsured patients failing to pay medical bills, she said Satilla has to rely on HELP. "When you go to the dentist or the vet, you know you have to pay. If you go to the hospital, why should it be different?" said Katrina Wheeler, Satilla's chief financial officer. HELP's Posa said that it's up to *Satilla and other hospitals to decide on appropriate interest rates: "What is right in one market may not be right for another."

Melvin Johnson, 55, another Satilla patient, has insurance, but his low-cost policy with AARP, the retiree-advocacy group, didn't cover the colonoscopy his doctor ordered in September. Johnson turned out not to have cancer, but the visit produced a bill for $3,304. He and his wife, Dolores, earn about $35,000 a year from her work as an outreach coordinator at a community health center and his construction job. Satilla's cut-off for charity care is twice the federal poverty level, or $27,380 for a two-person household. Unable to pay in cash, the Johnsons chose HELP. The 14.5% interest rate means their monthly payment comes to $125. "It has caused us to rearrange our budget," says Dolores, 35. "We've had to cut other expenses and reduce our savings." Satilla's Albert said the couple could have bought better private coverage. "They're saving money," the hospital manager said. HELP imposes a cost on the hospital, her colleague Williamson added, in that Satilla gives HELP an 8¢-per-dollar discount on patient debt.

Patient Focus

Some medical financing programs manage to turn a profit without charging patients conventional interest. Aequitas Capital Management, a private equity firm in Portland, Ore., provides financing through its CarePayment card to 50,000 patients treated at two dozen hospitals. CarePayment charges no interest on debts repaid over 25 months. Aequitas Chief Executive Robert Jesenik says his firm makes money by buying patient debts for about 80¢ on the dollar and then seeking to recover the full amount.

But patients aren't necessarily better off with CarePayment because they sometimes forgo discounts hospitals offer to people who pay in cash. At Spectrum Health, a nonprofit group of seven hospitals in Grand Rapids, Mich., self-pay patients who can write a check within 30 days receive a 20% discount; those who pay within six months get 10% off. Patients who charge their debts to CarePayment get no discount. Referring to CarePayment, Kathleen Engel, an associate professor at Cleveland-Marshall College of Law, asserts: "This is a markup, not a markdown." Engel, a consumer law expert, says that because hospitals effectively charge more when patients use CarePayment, the hospitals should disclose the price difference as the equivalent of an interest rate under the federal Truth in Lending Act.

Joseph Fifer, Spectrum's vice-president of finance, said its disclosure is legally sufficient. Steven M. Wright, Aequitas' senior managing director for health markets, agreed. Wright said Aequitas complies with the law by disclosing its payment terms when it sends CarePayment charge cards to new customers. From his position as chief financial officer of Methodist Le Bonheur Healthcare, a $1.2 billion nonprofit network in Memphis, Chris McLean has grown increasingly skeptical of all these developments. Five of his seven hospitals serve a large portion of Memphis' poor population. Instead of selling medical debt, Methodist gives self-pay patients a 50% discount. Many are then allowed to pay over five years, interest-free. The debts of many others are immediately written off. One of Methodist's facilities serves a wealthier clientele and another is the city's only children's hospital; those units subsidize the other five. "We get a lot of tax breaks, and for that we should *produce some community benefit," says McLean. "If we heal somebody medically, but we break them financially, have we really done what is in the best interest of the patient?"


Grow is a correspondent in BusinessWeek's Atlanta bureau. Berner is a correspondent for BusinessWeek in Chicago. With Jessica Silver-Greenberg.<!-- / message --><!-- sig -->
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Oregon Pioneer
04-05-2012, 09:25 PM
I don't want to sound like a heretic, but can some types of debt be good? What I'm speaking about are ways to combat inflation. Take for example my in-laws purchasing a 2,800 sq.ft. home on a beautiful piece of property for $7,000 in 1971. At $7,000 it would be the deal of the century now. Today though it's worth in the neighborhood of $280,000. In-fact wish I still owned my first house that I bought for $48,000 in 1994.

While we all know about the housing bubble bursting, we may have forgotten about our dollar's purchasing power going down, down, down every year. Some years are better than others. I can remember the late 70's when the U.S. had 22-23% inflation. At that point Americans had no reason to hang onto their dollars because 1/5th of each dollar was being clipped away each year. I think the government in an effort to make things look better than they are, came up with the Consumer Price Index- CPI. Now instead of calculating true inflation, they don't take into consideration fuel and food prices, and we all know how our gas bills have gone down in the last two years. Then maybe in today's modern society we don't need gas or food anymore.

What the housing bubble taught us was not to get overextended. Real estate like a lot of commodities and investments go up and down in cycles. Don't kid yourself, there were lots of people out there saying houses were overinflated, but many people had greedy dreams of easily doubling their money after a few years. Gold and silver at the time weren't even considered serious investments or at least were thought to be antiquated. Following the crowd probably is the worse way to invest.

With this being the election year we're hearing a lot about running a national debt or keeping up with our social programs. The fact is that if the government continues to spend money they don't have, the people/countries purchasing our debt will come to the realization that the payback won't be there or at least a concern thereof. Once the faucet is turned off, inflation rates will come back with a vengence. This would hurt the needy the most. I'm affraid we'll be looking at today's low housing prices and other inflation hedges with envy ten years from now. Doubt it? Ask your grandparents if they're around how much a loaf of bread or a quart of milk was when they were young. What did a movie cost or the price of a candy bar?