Ballad expands charity policy to help insured patients with high deductibles

Ballad Health on Monday announced it would reduce prices for patients without insurance, offer discounts to those who can’t afford their high-deductible insurance plans and use artificial intelligence to determine if patients qualify for free or reduced-cost care.

“We are extremely sensitive to the fact that there are people out there who aren’t able to pay what their insurance companies have imposed on them, and we are going to do what we can to help, but we are imploring on the insurance industry and general lawmakers to step in and realize this is not what the purpose of insurance was,” CEO Alan Levine said during a news conference.

“When you pay a premium, you have an expectation of reasonable out-of-pocket participation. But when you walk into an ER with a heart attack, you expect you are not going to be stuck with a $5,000 bill,” he said. “I don’t think that is an unreasonable expectation for patients to have. That’s why we are doing this, and our board feels pretty good about it.”

Ballad’s new policy:

  • Gives uninsured patients an 85% discount at all of the health system’s hospitals, physician practices, and urgent care and diagnostic centers.
  • Forgives or reduces the amount of deductibles and copays for insured patients, based on their income.
  • Uses public databases and analytic tools to determine whether patients qualify for free or reduced charges without requiring them to provide financial information or fill out complex forms.

The earlier charity policy applied only to uninsured patients.

Ballad Health has sued patients who failed to pay bills. Some may have qualified for charity care but did not apply for the write-off.

More than 5,000 lawsuits were filed in Virginia and Tennessee in Ballad’s last fiscal year.

“If we have people we have taken collection action against that would qualify for this eligibility, then yes, we will do the appropriate thing to apply this policy,” Levine said.

Levine said Ballad does not file warrants in debt for amounts less than $450 or if the person is unemployed or age 65 or older.

“We typically only file suit if we determine they have the capacity to pay and they are nonresponsive, or if they had a payment arrangement and they stopped paying and didn’t respond,” he said.

In an October interview, Tony Keck, Ballad’s chief population officer, said that while Ballad’s charity policy is generous, the paperwork sometimes is too daunting for people to fill out, especially if they have to gather documents.

He said it is similar to the hurdles schools have experienced in qualifying children for free or reduced-price lunches.

The new policy will rely on presumptive eligibility and will use artificial intelligence to determine whether a patient’s income falls within charitable guidelines. Levine said patients might not even be aware that their charges are being written off.

Ballad provides free care when a patient’s income falls below 225% of federal poverty guidelines, or about $28,000 for an individual and about $58,000 for a family of four. It reduces the bill for incomes up to 450% of the poverty guidelines, or about $56,000 for an individual and $115,800 for a family of four.

Ballad says people earning the median income in its service area would be eligible for a 100% write-off.


Levine said only a quarter of the health system’s patients have commercial insurance, and some are delaying care because they can’t afford to use their policies. This, he said, can lead to more complex and costlier illnesses once they do seek treatment.

Also, he said, some patients don’t understand that their insurance doesn’t begin to pay until after they have paid thousands of dollars to cover their deductibles.

He said people in Ballad’s finance office are often in tears over the stories they hear. Levine did not place a figure on what it is costing Ballad to expand its charity policy, but he said the policy is more in line with what it is already experiencing with patients’ inability to pay high deductibles.

Levine warned that this type of expanded charity care isn’t sustainable. Rural hospitals such as Ballad, with a large percentage of patients who are uninsured or on Medicare and Medicaid, already have narrow profit margins.

Ballad is required to meet charity care goals by both Virginia and Tennessee.

It said in its annual report that it provided more than $37 million in charity care and more than $12 million in subsidized health services during fiscal year 2019 but did not provide details.

Spokeswoman Teresa Hicks said the figures are preliminary and will be made public in Ballad’s IRS 990 filing once they are finalized and audited.

Patients should call 423-431-1700 or 423-408-7400 for information about the charity policy and to learn whether they qualify.

[This article was originally published by The Roanoke Times.]