Allina suspends policy that denied care to patients with large debts

Allina Health is pausing its practice of denying non-emergency clinical care to patients with substantial unpaid medical bills.

The Minneapolis-based health provider announced the decision Friday along with plans to talk with community leaders and its own doctors about ways to help patients who are struggling to pay their bills.

"We are committed to listening to our community and working to better understand the barriers to accessing the financial support available to our patients," said the statement from Allina's chief executive, Lisa Shannon.

The announcement came one week after a New York Times story publicized the policy, and Minnesota Attorney General Keith Ellison invited any patients affected by it to contact his office for investigation.

Patients under the Allina policy weren't able to make appointments with clinical providers if they had three or more instances of $1,500 in unpaid debts. Allina officials stressed that the paused policy only affected clinical care, not hospital care.

Before the policy took effect, patients should have received 20 billing statements or phone calls that mentioned payment options and financial assistance. However, the pause was partly a recognition that Allina hadn't given its clinicians enough information to pass along to patients and help them avoid any denial of care.

Allina estimated that the restriction affected about 2,000 out of 1.9 million clinic patients per year. The policy previously had been suspended at the start of the pandemic but restarted in 2021.

Attorney Margaret Henehan said she has helped patients with medical debts regain access to care at Allina, as well as at Mayo Clinic in Rochester and other providers across Minnesota. Cutting off patients has become more common in recent years, following the COVID-19 pandemic that increased financial pressure on hospitals, she said.

Filing for bankruptcy is usually the quickest protection, because it suspends collection efforts and restores access to care. Southern Minnesota patients face a particular challenge if they lose access to Mayo, said Henehan, a partner with Kain-Henehan in Mendota Heights.

"Mayo has got such a hold on all of those towns in southern Minnesota," she said. "When you get cut off from Mayo, you really get cut off from health care."

Mayo was identified by a Kaiser Health News investigation in 2022 as one of 90 U.S. medical providers that denied care to patients with unpaid bills. Amery Hospital and Clinic in western Wisconsin also was identified in the investigation of 500 hospital and clinic systems. The investigation included Allina's Faribault medical center but could not determine the extent of its policies.

The practice was troubling to U.S. Health and Human Services Secretary Xavier Becerra, who was in Minneapolis on Thursday.

"If you go into the medical profession and you are going to follow the dictum that says, 'Do no harm,' then the worst thing you can do is be a medical provider and not give people access to the care that you were trained to provide," he said.

The reasons people don't pay their medical bills can vary. Some have no insurance or are eligible for public programs but don't know it. Others have high-deductible plans that leave them with cost-sharing levels they can't afford.

Federal law guarantees access to emergency medical care. Minnesotans over the past decade also have had the added protection of an agreement between the attorney general and hospital providers that prevents abusive debt collection practices.

The agreement includes clinic and outpatient services, and limits providers on their debt collection and wage garnishment tactics. It also ensures discounted rates for uninsured patients. It does not specifically address whether providers can suspend access to patients with unpaid debts, but could apply if the denial is considered a coercive collection practice.

Ellison in a statement Friday said he remained concerned, despite Allina's pause on its policy.

"In the last week, my office has heard from a good number of Allina patients who have shared their own upsetting stories of being denied care for this reason," he said.

Statements from the Essentia, Fairview and Sanford health systems indicated they do not have comparable policies. HealthPartners acknowledged a limited use of the policy to resolve debts.

"We use scheduling holds as a last resort, and only in non-urgent circumstances, to engage with patients and try to connect them with assistance," said a statement provided by HealthPartners spokesman David Martinson.

A statement provided by Mayo spokeswoman Kristy Jacobson said that the health system provides financial counseling even before care is provided to try to avoid saddling patients with bills they can't pay.

"We also help patients create reasonable and extended payment plans with no interest as needed, and we often provide financial assistance if a patient is unable to pay their bill," the statement said.