In some cases, rape victims were held financially responsible for medical expenses
In August, we spoke to a young woman who got an expensive emergency room bill after being raped. The woman thought she shouldn't have to pay and we reported she likely wouldn't have to because there’s a fund that can help victims in Arkansas. But it’s not as simple as finding a hospital, filling out a form, and following through.
This woman is not alone though and something is being done to protect victims from being financially responsible for their rape.
Roughly 21 percent of women in Arkansas have been raped at some point in their lives. That's according to the Intimate Partner and Sexual Violence Survey, which said that's likely a very conservative estimate.
Many of the victims won't go to the hospital for treatment, but for those who do, there are many unknowns, including how much the bill will be once they get home.
The woman we spoke with went to Baptist Hospital for a sexual assault exam. A week later she got a bill totaling nearly $600.00 for the procedure.
"It's not like I wanted to go and have a rape kit done, because it's very intrusive," she admitted. "Especially after what happened."
In the past two years, the Arkansas Crime Victims Reparations Program has helped 6,000 victims who have suffered a personal injury or death. Many of the victims are the survivors of a sexual assault of some kind. The program uses state funds to offer up to $10,000 to a victim. Currently, $3 million is allocated for those who qualify.
But there is a limit on how much a victim can receive and sometimes hospitals don't get fully reimbursed even if the victim has insurance.
"We are seeing here in our hospital about 100 cases a year, 120, somewhere around there," said Sherrie Searcy, a sexual assault nurse examiner at UAMS. "And we are just one hospital in this local area, so you imagine the number across the state."
Searcy said the rape kit and STD testing, the part that can be compensated for hospitals, is only a portion of the rape treatment process.
"We offer them HIV prophylaxis, STD prophylaxis, pregnancy prophylaxis, lab work for baseline HIV status, hepatitis, we will check their kidney and liver function," she explained.
But Searcy said UAMS has seen "minimal compensation" and the hospital eats much of the cost for uninsured victims.
"On average, about $236 is what I'm seeing refunded to the hospital. Our bills are around $3,000 for the whole care,” Searcy said.
We reached out to the four hospitals in Little Rock about proper procedure for billing sexual assault victims. And depending on which hospital you visit and how much insurance coverage you have, a victim could be expected to pay nothing, thousands of dollars, or anything in between.
After reviewing their policies, we realized none of the hospitals' policies matched the law, according to the Attorney General's Office.
"For any sexual assault exam -- those expenses should accompany a [sexual assault] reimbursement form and sent directly to our office," a spokesperson for Attorney General Leslie Rutledge said. "Bypassing insurance is perfectly fine. In fact, we ask providers not to bill private insurance for sexual assault charges. However, there is no law that says they cannot bill insurance. Hospitals are to send bills and applications to our office on behalf of all sexual assault patients. It is the providers' responsibility to get this to our office, not the victim's."
When we reached out to the hospitals about the law, each of the four had revised their statement to some degree. [A list of their positions can be found at the end of this article]
"It obviously says a due date and they sent me a financial aid assistance letter on how to do payment plans or something, to pay them for my visit to the hospital,” said the woman we spoke to when asked for a response to Baptist’s statement.
Louise Allison, founder of PATH, a safe place for victims of sexual assault and human trafficking said it isn't fair for the victims to have the burden of paying for their medical expenses.
"They didn't electively choose to be raped, and now they have to choose between, 'Do I pay for these really expensive medications or provide the care that my child needs? Or put food on the table?' That's not ok,” she said.
Allison has spent many a day in an ER with victims, and said the care victims receive is also not the same from one hospital to another.
"I think it would be great to have basic standards of care across the board, regardless of what hospital the girl goes to after the initial assault," Allison said. "The SANE nurse, or sexual assault nurse examiner is not available at all facilities. The care that is provided it not across the board at all facilities. And a girl is not going to go from one hospital to another over and over and over again trying to get the care she needs."
The woman we spoke to said the lack of uniform care and potential costs associated with rape kit testing forces many victims to simply stay silent and not report the crime.
According to the National District Attorney's Association, an estimated 63 percent of sexual assaults are not reported to police. One reason someone may not report their sexual assault is it might compromise their confidentiality.
"If she has insurance, and she's expected to file that insurance through that insurance policy, but the policy holder is the one that committed the rape, she does not want to file through her insurance company,” Allison explained.
She said that if the perpetrator finds out the victim is pursuing charges, the victim could get in a lot of trouble. That's why, Allison said, it's in the public's best interest that these victims get the care they need and the confidence to report to police to get the sexual predators off the streets.
"If she doesn't get the care she needs, or it becomes too complex, or too cumbersome, or too worn out in the process, she's not going to press charges," Allison said.
In the end, the woman did not end up paying anything.
But, while the hospitals say patients should be in contact with them if they feel they have been billed inappropriately, Louise Allison said victims often won’t. They avoid doing anything to relive the trauma again.
Allison is already at work to propose legislation that would ensure rape victims never get a bill. In fact, the rapists would be held financially responsible.
Below are the hospitals' positions as of November 13, 2017:
If the patient has insurance, UAMS will bill the insurance company first, whatever isn't covered is billed to the Crime Victim's fund.
If the patient doesn't have insurance, UAMS will bill the fund first, eating the remaining cost for uninsured victims.
If a victim receives a bill, they are to contact UAMS to ensure there's an application put on file for them.
UAMS policy says payment by the board shall be considered payment in full.
Arkansas Children’s Hospital
Arkansas Children's Hospital also bills insurance when that is available. If patients don't have insurance, they're referred to the AG's office.
CHI St. Vincent
CHII St. Vincent says its policy is not to charge any fee for a rape kit, adding that sexual assault victims are not required to cover the cost of any treatment.
From time to time, they say, a patient's insurance will also be billed, with the Crime Victims Reparations Program listed as a secondary payer.
In August, Baptist Hospital originally said, "All patients who receive services in our Emergency Department trigger charges such as, but not limited to: lab work, radiology, pharmaceutical costs, and physician examinations."
But as of November 13, the hospital said, "Baptist Health does not bill patients for a rape kit, we do not bill patients insurance or for other services associated with a rape diagnosis."