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Karen* was 26 when her partner drove her to an ER in Boston the morning after she was sexually assaulted. She opted for a pregnancy test, pre-exposure prophylaxis anti-HIV treatment, and an IV. She assumed her insurance from her job as a certified rape crisis counselor would cover the costs.
But four months later, she received a bill from the hospital. It contained a breakdown of what her insurance covered and what she owed — and it exceeded $1,200.
Karen is not the first sexual assault survivor to get surprised with exorbitant fees. Despite the law's intentions of offsetting medical expenses that should not have to be paid by the sexual assault survivor (and it's not taxpayer dollars covering the costs, but rather funds from crime victim compensation programs), some hospitals are extraneously billing the patients for tests and treatments, further contributing to their distress.
In a recent study published in the American Journal of Public Health, researchers analyzed the insurance policies of 1,355 female rape survivors between the ages of 16 and 61. They found that nearly all of them paid healthcare costs — an average of about $950 — for crimes committed against them. The study found that while insurance typically covers 86% of the $6,737 average cost of rape, including for items like a rape kit — an involved exam that collects forensic evidence for a tailored treatment program or to support court proceedings should you wish to prosecute — survivors are generally left to cover the remaining amount out of pocket. Between antibiotics, sleep aids, anti-anxiety medications, emergency contraceptives, and other related treatments, the study showed some survivors accrued up to $8,900 in charges in the first month alone.
The cost is even more disheartening given that protection clauses in the law like the Violence Against Women Act (VAWA) were established to prevent hospitals and healthcare providers from billing survivors after their assault. Still, many providers in the country have figured out how to tack on extra fees, Michelle Katz, a licensed practical nurse, health insurance advocate, and author of Healthcare for Less, 101 Health Insurance Tips, and Healthcare Made Easy, tells Teen Vogue. She says that depending on the facility, physicians often charge a professional component associated with their expert reading of the diagnostic or lab work, a site fee for the cost of the room and equipment, and a technical fee for the kit itself. This begs the question: Are hospitals unnecessarily billing survivors?
When Karen first provided her insurance information to the hospital immediately after the attack, she said she was in no state to ask about any hidden fees or what portion of the treatment her insurance would actually cover. By the time she was mentally prepared to pay the balance seven months after the assault, the hospital had already contacted a collections agency. They then settled on a payment plan, where she ended up paying in $10-a-month increments over the course of two years.
Facilities across each state use different processes for paying for forensic materials, Jennifer Pierce-Weeks, a registered nurse who is also a sexual assault nurse examiner and Chief Operations Officer of The International Association of Forensic Nurses, tells Teen Vogue. Emergency rooms are required to see patients without any expectation of payment, making it difficult to gauge if and how much survivors will end up paying.
Katz says the laws state that in the aftermath of sexual assault, a survivor should not be sent a bill for "critical ER services that place an important role in helping law enforcement make an arrest and work to achieve justice for the survivor." But that's not always the case. She says there's "a negotiated rate between [hospitals and insurance companies] and in the end, whatever the insurance does not cover, the hospital might try to 'balance bill,' — when a provider bills you for the difference between the provider's charge and the allowed amount — which is actually illegal, but no one really complains."
Despite a recent threat looming large surrounding the future of Obamacare, Senate Republicans did not receive enough votes to move forward with the "skinny repeal," a bill that could have resulted in over 16 million Americans losing health insurance by 2026. With sexual assault excluded from the list of pre-existing conditions, survivors can continue to rely on their insurance companies for rates that do not discriminate against crimes committed against them. But as Katz points out, survivors have still been reporting high costs associated with their assault under the current system. So, what's the solution if you find yourself in that situation? "It depends on your insurance...because hospitals and clinics have become savvier at figuring out how to bill you for a service that's supposed to be covered by the law," she says. "In essence, a good and creative attorney will always find a loophole in any law." But an attorney's role isn't necessarily to help you file a lawsuit. Due to the complexity of our healthcare system, an attorney may have to enforce rules in the event that providers misinterpret contracts.
"I have had to help people fight many battles about this and unfortunately the billing departments may not take you seriously unless a JD gets involved. But who is going to pay a JD when you have a bill to pay too? That is the dilemma," Katz says.
Government-enacted programs for survivors like crime victims' compensation help alleviate some of the costs. But for Karen, getting reimbursed wasn’t so simple: “I think I logically knew [about victims compensation] but didn't consider it, and honestly the thought of dragging out the process and paperwork wasn't something I could think about or handle.”
While certain survivors opt out of acquiring a rape kit in fear it will further contribute to the existing trauma or incur exorbitant bills because of it, Lindsey, who asked that Teen Vogue not use her last name, had a different experience. She said the state of Texas was incredibly proactive about covering healthcare and legal costs in a timely manner through crime victims' compensation.
On the night of November 30, 2012, Lindsey was leaving her local CVS when she walked into her car alone. Next thing she knew, a man approached her and put a gun to her head, and told her he would pull the trigger if she made a single noise.
Details are blurry, but Lindsey recalls being forced to drive to a hotel. He then trapped her there for 13 hours, during which she was beaten and raped. He stole all of her identification and money out of her purse. Once she noticed his gun on the nightstand when he went to the bathroom, she bolted for her car, and fled home.
Her best friend, who worked for the Houston Police Department, convinced her to contact authorities. Eight months later, the district attorney contacted Lindsey to say they found the perpetrator. The same DNA on her rape kit was collected from that of three other women.
“We all testified. And the district attorney and the whole prosecution team was amazing,” she tells Teen Vogue. For Lindsey, reporting her assault and receiving compensation in a timely manner was therapeutic.
“I think a lot of women who go through sexual assault aren't aware of the support programs for them. I'm lucky that I had one that was very supportive and helped me fully utilize the things the states provide for support. I was given access to free counseling with an amazing counselor,” she says.
Kathryn Williams, Director of Corporate Communications at Memorial Hermann Health System where Lindsey sought treatment, told Teen Vogue patients must be screened for the presence of an emergency medical condition without taking into consideration their ability to pay. “Victims of crimes presenting to emergency rooms would be treated in the same manner. The care and treatment of sexual assault and other victims of crime may extend well beyond the initial forensic exam. In some cases, victims may require additional treatment including, but not limited to, hospitalization.
“In a perfect world, there would be no assault victims and no one requiring this kind of emergency medical care,” Williams adds. “As long as these services are still required, we will continue to be there for those patients in their greatest time of need and provide them with compassionate, supportive, quality care. Our hope is that all patients have experiences similar to the patient in your story.”
No matter what, Pierce-Weeks says survivors are never alone, and should always take advantage of resources available to help them navigate the painful aftermath.
“Don’t let payment issues stop you from getting the medical treatment you need...No matter what, somewhere, there is a community crisis center and they know precisely the way the system works locally.”
- Some names have been changed.
If you or someone you know has been sexually assaulted, you can seek help by calling the National Sexual Assault Hotline at 800-656-HOPE (4673). For more resources on sexual assault, visit RAINN, End Rape on Campus, Know Your IX, and the National Sexual Violence Resource Center.
Related: How Rape Helped Me Love Myself More
