Blind Americans pay time and money for inaccessible bills

Blind Americans pay time and money for inaccessible bills

(TNS) – A deaf-blind Missouri man says a medical bill he didn’t know existed was sent to debt collectors, causing an 11% increase in his home insurance premiums.

An insurer has suspended coverage for a blind woman every year since 2010 after she mailed printed “benefit verification” forms to her California home that she cannot read, she said. The problems continued even after she called a lawyer.

And another insurer continued to send a visually impaired Indiana woman bills she said she couldn’t read, even after her complaint to the Civil Rights Office of Health and Human Services led to action corrective.


Anthem Blue Cross has suspended Lucy Greco’s health coverage every year since 2010 after she sent printed “benefits verification” forms to her home in Berkeley, Calif., which the blind woman cannot read, she says.

(Shelby Knowles/KHN/TNS)

Health insurers and health care systems across the United States are violating disability rights laws by sending inaccessible medical bills and opinions, a KHN investigation found. The practice hinders the ability of blind Americans to know what they owe, creating a disability tax on their time and finances.

More than 7 million Americans 16 and older have visual impairments, according to the National Federation of the Blind. Medical information and billing provided in an accessible manner is a right protected by various laws, including the Americans with Disabilities Act, the Affordable Care Act and the Rehabilitation Act, disability rights legal experts have said.

But the blind patients said KHN that the letters they receive may be impossible to read if they are not in large print, depending on their level of visual impairment. Some websites have coding incompatible with screen reader technology, which reads text aloud. Some health care systems and insurers fail to send documents in Braille, which some blind people read by touch.

“I tell them that mailing me in fine print is like hiring a mime to communicate with me from outside my window,” Stuart Salvador said via Skype instant messaging. The 37-year-old lives in Greene County, Missouri, and has only residual sight and hearing after a case of shingles when he was 28. “I can tell there’s something to it, but I have no idea what I’m supposed to be getting out of this.

Salvador said it took him up to six hours to efficiently convert a printed medical bill to Braille. He said he was repeatedly sent to collections by CoxHealth and Mercy hospital systems through their automatic medical debt referral systems after they sent him bills he couldn’t read. As a result, he said, his home insurer increased his annual premium by 11%, costing him an additional $133.51 and hassle.

Nancy Dixon, spokeswoman for Mercy, said the health system could not find a bill for Salvador that was sent to collections in its records for the past 10 years, and that its policy is to make reasonable accommodations for any patient who requests them. CoxHealth did not respond to requests for comment.

Salvador noted that it is difficult for him and other visually impaired patients to struggle to access their billing information. If they realize there is a problem, he and other patients say KHN, communicating with medical systems and insurers can be difficult. But often they are not aware of the problem until it is too late. Like Salvador in this case, some blind patients don’t keep track of written documents they can’t see, which could otherwise help a potential legal challenge when overdue billing issues escalate.

Disability rights lawyer Albert Elia, who is blind, said blind people struggling with inaccessible bills often find themselves with two options: hope for government action or pursue lengthy and costly lawsuits. The National Federation of the Blind and the American Council of the Blind have sued and won public settlements regarding inaccessible medical information.

Meredith Weaver, a senior attorney at Disability Rights Advocates, which helped oversee the implementation of a blind accessibility settlement agreement with healthcare giant Kaiser Permanente, said her clients often ask for the documents be sent in Braille or readable by online screen readers. They then usually receive a document that suits them before the cycle begins again.

“It was like a mole to continually make these requests,” she said.

After the terms of the settlement agreement with Kaiser Permanente expired in 2018, Weaver said, she began hearing from clients who were again running into the same hurdles.

Kaiser Permanente spokesman Marc Brown said the health system conducted an accessibility review after KHN informed him of Weaver’s comments, and he said the company found “no material flaws in the platform, and we are not aware of any inaccessibility issues” that would prevent someone from paying their bill or to use its website. (KHN is not affiliated with Kaiser Permanente.)

KHN found several accessibility issues on the public webpages of Aetna, Anthem Blue Cross, and UnitedHealthcare, the major insurers that visually impaired and blind customers have reported as having accessibility issues. errors, which KHN identified using a tool created by WebAIM, a non-profit web accessibility organization, include web page coding that would make it difficult for a blind customer using screen reader technology to shop for a plan of health or to find a doctor in network.

After learning KHN‘s, Andrés J. Gallegos, chairman of the National Council on Disability, an independent federal agency that advises the White House and Congress, said the council should investigate the matter further.

“It’s shocking to the conscience,” he said, noting that the law clearly provides such accessibility protections.

The three insurance companies said they are working hard to make their services accessible and trying to resolve member issues.

“We are in 2022. Everything is done electronically; it’s all done online,” said Patrick Molloy, a 29-year-old blind man from Bucks County, Pennsylvania. “In theory, it shouldn’t be very difficult to make websites and billing platforms accessible to visually impaired customers. But that’s the world we live in.


Lucy Greco filed for legal aid in 2020 to stop Anthem Blue Cross from sending her printed notices she can’t read, she says. She now receives some, but not all, communications via email, which she requested, and an online portal.

(Shelby Knowles/KHN/TNS)

Hiring a lawyer doesn’t always solve the problem, said Lucy Greco, a web accessibility specialist at the University of California, Berkeley. The 54-year-old blind applied for legal aid in early 2020 to stop Anthem Blue Cross from mailing out her printed notices that she can’t read – which has sometimes resulted in benefits expiring as she doesn’t could not read the request for signature and return. She now receives some, but not all, communications via email, which she requested, and the company’s online portal.

Greco employs an assistant to read her mail to fill in the gaps every two months, but she always missed insurance notices and bills. She recently raised the aide’s pay to $30 an hour because Greco wants to make sure she can retain someone she trusts with all of her personal information. But not everyone can afford to hire an assistant.

“It makes you feel helpless and makes you feel dependent on people you might not want to feel dependent on,” she said.

And even when federal entities step in to solve these problems, they persist. Kate Kelly, a 61-year-old woman in Greenwood, Indiana, who suffers from visual impairment and hearing loss from multiple sclerosis, was so sick of receiving multiple standard-size text bills from her insurer, Aetna, that she filed a complaint with the HHS Office for Civil Rights in early 2020.

But after the office reached an agreement with Aetna to stop sending its standard-size text invoices this fall, she said, Aetna quickly went back to sending documents in text too small for it. can read them. Kelly pushed HHS to reopen her case. In July, records show, the office closed it due to what it said was a lack of jurisdiction, despite its involvement in securing the previous resolution.

She said her large-print invoices are always delayed – one from March just arrived in August – and she now has to sign for them when they are delivered. When she tried to use the online portal, she said, her screen reader couldn’t read some numbers and other information.

“It’s hard to fight back; it is difficult to participate in the system,” she said. “You see why insurance companies get away with it because it’s not easy to enforce these laws.”

Alex Kepnes, a spokesman for Aetna, said company employees contacted Kelly after KHNand they “regret the inconvenience it caused him”. Kelly said she missed Aetna’s call, and although she called the next day and tried one more time, she still hadn’t heard back on Nov. 28. She received a complaint form from the company – in fine print that she cannot read.

Meanwhile, Kelly said, her utility company manages to send her a bill in large print every month. And she pays it off quickly.

©2022 Kaiser Health News. Distributed by Tribune Content Agency, LLC.

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