Survivors of sexual assault often receive unexpected medical bills for critical care, but lawmakers and physicians are pushing for new ways to address this staggering problem.
On Monday, a group of bipartisan lawmakers introduced a bill called the No Surprises for Survivors Act, which is designed to ensure that patients with private health insurance do not have to pay out-of-pocket costs or surprise medical bills for forensic medical exams, commonly known as rape kits.
In announcing the introduction of the bill, Reps. Linda Sánchez (D-Calif.), Gwen Moore (D-Wis.), and Carol Miller (R-W.Va.) said that while the Violence Against Women Act (VAWA) of 1994 authorized federal funds to be used for services that support survivors of sexual assault, independent analyses have found that some survivors continue to receive surprise bills and can be left to pay for them out of pocket.
In a correspondence recently published in the New England Journal of Medicine (NEJM), a group of physicians and public health experts detailed the thousands of dollars in costs that are still faced by many survivors of sexual assault.
“The VAWA allows health care facilities to bill for diagnostic testing, laceration repair, counseling, prevention of sexually transmitted diseases and HIV infection, and emergency contraception — a provision of the law that is especially worrisome, especially since many states have outlawed abortion,” the authors of the correspondence wrote.
They further noted that, in 2019, sexual violence was a coded diagnosis for an estimated 112,844 emergency department visits. Most patients (88.3%) were female, 38.2% were 17 years old or younger, and 52.7% were between the ages of 18 and 44.
Of these patients, 36.2% had Medicaid and 22.1% had private insurance, while 16% were expected to pay out of pocket. Overall, emergency department charges averaged $3,551, and victims of sexual abuse during pregnancy incurred the highest charges ($4,553). Charges for self-pay patients — which some hospitals may discount — averaged $3,673.
However, it isn’t just the financial costs that are detrimental, the authors noted, pointing out that emergency department charges may discourage survivors of sexual assault from reporting rape and seeking medical care in both the short and long term. Such charges may disclose “potentially stigmatizing events” to family members or employers, they added, and charges may “further traumatize survivors by suggesting that they are personally responsible for their assault.”
Co-author Samuel Dickman, MD, of Planned Parenthood of Montana, told MedPage Today that while previously working as a doctor in Texas, “I would routinely see patients who had been victims of rape, and some of them told me that they were dealing with medical bills after going to the emergency room, or that they hadn’t even wanted to go to the emergency room because they knew they would be hit with medical bills.”
“It’s just an incredibly tragic way that our healthcare system fails survivors of rape and abuse, which is that they are often asked to pay thousands of dollars for this medical issue,” Dickman said.
The No Surprises for Survivors Act would require private insurers to provide coverage, without cost-sharing, for forensic medical exams regardless of where they are administered (unless reimbursed by the state under VAWA), according to its co-sponsors. It would also require the exams to be covered under the emergency services protections of the No Surprises Act, regardless of where they are performed.
The bill further states that if an individual receives a forensic medical exam where the state is responsible for the out-of-pocket costs associated with the exam, “private insurers must provide appropriate notice to help victims avoid bills and streamline the reimbursement process.”
Dickman noted that, however staggering, the numbers included in the NEJM correspondence were “certainly an underestimate” of the actual number of patients expected to pay out of pocket for services. Furthermore, those most likely to be victims of sexual violence — young women from low-income communities — are also those most likely to not have health insurance, especially in states that haven’t expanded Medicaid, he said.
In order to have access to VAWA protection, a survivor of sexual assault needs to be able to disclose that information, and for many reasons, that often doesn’t happen, Dickman added. In addition to expanding VAWA, he proposed broader reforms, such as universal healthcare coverage, that would further protect survivors of sexual assault, regardless of whether they are able to disclose what had happened to them when they seek care.