Eight years ago, Terry Maher, a professional bassoonist living in Champaign, Illinois, was unexpectedly charged a hospital “facility fee” for allergy shots that she had received from her local doctors’ group, Carle Health, every three weeks for years.
“I freaked out,” Maher recalled. “I had to pay co-payments on these things and they said as soon as you step into a facility, you get charged. And I'm thinking, ‘To get my allergy shots?’”
She called her insurance provider, who told her they had talked with Carle officials about what types of services they would bill for and “they said nothing about this,” Maher recalled. Within two weeks, after Maher’s story became public in her local newspaper, Carle reversed course and said patients receiving allergy shots would not have to pay the facility fee.
But bad feelings lingered.
“After that happened, things have not been so warm and fuzzy toward Carle, because people are really angry,” Maher said.
Fast forward eight years, and Maher had a choice: Either go back to Carle, the region’s biggest hospital system and the operator of a state-run mass vaccination site, or someplace else for a COVID-19 vaccine.
She chose to get the vaccine through her local public health department instead. Maher had heard, from other Carle patients, that people were getting bills for shots. In almost all cases, people were being asked to show their insurance cards requested at the door. It’s legal for vaccine providers to ask for insurance and bill providers for administrative fees but the federal government ensures that patients incur no out-of-pocket costs to get the vaccine.
Carle, the leading healthcare provider in Champaign-Urbana and with locations across Illinois, has had a long, sometimes complicated, history with patient billing. And its decades-long reputation for aggressively billing patients — double-billing for routine hospital visits, filing injunctions and pursuing patients in court, with threats of arrest — has resurfaced anew.
It has led some public-health experts to wonder aloud whether Carle’s business model has caused a region-wide chilling effect for those so concerned about the potential of being billed that they avoid getting the vaccine at Carle — or anywhere else.
In an interview, Carle’s chief operating officer, Matt Kolb, defended the hospital system’s vaccine work, saying Carle staffers have worked tirelessly to combat vaccine misinformation and encourage those to get vaccinated free-of-charge at their five locations.
“We've worked hard to continue to build trust with our patients,” Kolb said. “I think since 2013, or times in the past, we've come a long way in terms of communication with patients around costs and billing and the rest.”
The hospital points to nearly 106,000 vaccine doses it’s administered, including 56,500 full vaccinations, and Illinois statewide NRC Health surveys that show the chief reasons for vaccine hesitancy are not cost but rather fear of side effects and worries that the process in producing vaccines was rushed.
But even patients who went to a Carle Health clinic for a vaccine told the Brown Institute for Media Innovation’s Documenting COVID-19 project they were hesitant to go, for fear of eventually getting charged for the visit. At least 30 Carle patients were erroneously billed this spring for COVID-19 vaccine shots, which the hospital system said was quickly corrected.
Public health experts say that kind of fear — however mistaken — could have a devastating impact on the final leg of the country’s COVID-19 vaccination campaign.
Patients with past Carle run-ins charged fees for vaccines
The Champaign–Urbana metro area includes the cities of both Champaign and Urbana, with a combined population of more than 130,000, and is home to its eponymous University of Illinois campus, the largest university in the state with more than 47,000 students.
For many of those who live in Champaign and Urbana, the nonprofit Carle Health is an outsized, ubiquitous presence. Carle Health has more than 11,000 employees and boasts a ranking as one of America’s 50 Best Hospitals by Healthgrades.
It has also been one of the most profitable hospitals in the U.S, and Carle Health and the Carle Foundation Hospital has received tens of millions in federal CARES Act funding, according to CDC data.
But Carle also has a reputation for its aggressive billing methods, including at least three cases in the early 2000s when debtors were arrested or faced legal repercussions for failing to pay their medical bills.
Carle was also engaged in a yearslong court battle with multiple local authorities — the city of Urbana, Cunningham Township and the Illinois Department of Revenue — over property tax exemptions and its nonprofit status. Carle eventually won that legal battle in February 2020, over the objections of local and state agencies.
The Carle Foundation Hospital stopped arrests of its debtors in 2004, saying at the time that its practice of using collections agencies to use court-ordered arrests to get payments from patients was “rarely used” and a “method of last resort.”
But billing issues have persisted, with patients complaining of skyrocketing costs since Carle switched to a provider-based billing model and reclassified certain areas as hospital outpatient areas, bringing higher Medicare reimbursements.
Carle was referenced by name on a private Illinois Department of Public Health conference call with local health departments in early March, when Champaign-Urbana Public Health District Administrator Julie Pryde told state officials that a “unique historical fear of Carle Health Care due to past various billing practices where people were arrested for unpaid bills, which has changed, but community fear remains,” according to minutes of the meeting obtained through a Freedom of Information Act request by the Documenting COVID-19 project.
In an interview, Pryde said billing issues, like the ones at Carle affecting just a few dozen people, tend to “reverberate way, way, way farther” than those initially affected.
“There's just a lot of residual distrust there within certain communities,” she said. “It's almost generational like they may not have even had an experience with it, but they have heard about it. One of the things that we're doing is to just continually say to the public, there will be no out-of-pocket cost to you for this vaccine — period.”
The state health call didn’t include discussion of more recent issues surrounding Carle’s billing of COVID-19 vaccine shots. In mid-March, Carle Health said it unintentionally charged 30 uninsured patients for COVID-19 vaccinations, according to the News-Gazette. While the hospital said it would be sure not to erroneously bill future vaccine recipients, several Carle patients the Documenting COVID-19 project interviewed have since been billed for both vaccine doses, as recently as April.
When Patricia Kemme, a retired chemist with the U.S. Army Corps of Engineers, got both doses of the Moderna coronavirus vaccine in April, she was surprised that the provider, the nonprofit hospital system Carle Health, charged her an administrative fee for both shots — $55 for the first and $95 for the second.
Her insurance company, Aetna, told her not to pay the bill and that it would eventually be removed. And, within a few days, it was.
“It was kind of weird,” Kemme said. “They had volunteers working to get people signed up for the second dose and yet they upped the price. But I guess that's Carle.”
Kemme had dealt with Carle before. She had paid thousands for an MRI several years earlier, a charge she felt was far too high.
Adam Smith, a researcher who has lived in Champaign County for 30 years, saw identical charges to Kemme’s on his own insurance bill. He had first tried to get a vaccine appointment through the health district but ended up going to Carle because he couldn’t find any other open appointments.
Smith said he tried to avoid Carle “because of the threat or fear of the facility fee. But I wanted to get the vaccine as soon as I could, and their appointments were much more available.”
Tom Trumpinski, a retired scientist, said his insurance was billed for administrative fees related to both of the Moderna shots he received at a vaccine clinic held in a former Dress Barn store. Similar to Kemme, Trumpinski’s Medicare provider was charged a first administrative fee of $55 and a second of $95, for a total of $150. That’s a modest, but still notable, increase from the $39 per patient price of the Pfizer vaccine. Trumpinski said almost everyone he knows has had to show insurance when getting vaccinated at a Carle facility and that the request to bring proof of insurance was common among all vaccine clinics in North Central and Central Illinois.
Claudia Lennhoff, executive director of Champaign County Health Care Consumers, a local advocacy group focused on health care, said Carle discovered the March billing errors and worked to correct them quickly.
But told of the new billing issues in April, Lennhoff said her main concern is to “make sure that no one is stopped from getting the vaccine upfront because of a demand for payment.” She emphasized that no one was billed at the time of service, so the billing errors did not prevent anyone from getting a shot upon arrival at a vaccine clinic site.
Indeed, Champaign and Urbana are among the most vaccinated communities in Illinois — Champaign County is the state’s third most vaccinated, with nearly 34% of the county’s 210,000 population fully vaccinated as of May 10, according to state figures.
Carle said it has worked with the public health district to coordinate messaging and outreach and combat vaccine hesitancy.
“We've been very vocal about the importance of the vaccine and tried to understand any barriers that exist to people, be they financial barriers, or concerns about efficacy, concerns about safety, and have tried to address those,” Kolb said. Carle Health runs five vaccine locations, including two in Vermilion County and one each in McLean and Woodford counties.
“We're really here to help,” Kolb, Carle’s COO, said. “There should be no cost for patients to receive the vaccine. And we want as many people as are eligible to receive it to be vaccinated.”
Carle officials said they spoke with several patients who received a statement from their insurance provider — sometimes called an “Explanation of Benefits” — or saw a bill on their online account, which caused them to mistakenly think they would incur a cost.
Public health experts say vaccine hesitancy comes in many forms, and trust between providers and patients is one of the few effective solutions. Even then, it’s arduous, time-consuming work that can take years to produce meaningful results, experts say.
“These are very valid concerns, which I think will only need to be addressed again and again and very transparently,” said Dr. Vidya Sundareshan, a professor of infectious diseases at the Southern Illinois University School of Medicine and the medical adviser in Sangamon County, Illinois. “It's most important to be transparent, honest, upfront and consistent.”
The Documenting COVID-19 project at Columbia University’s Brown Institute for Media Innovation is a collaborative FOIA journalism effort to compile newsworthy records and data related to the coronavirus pandemic. For more information, email firstname.lastname@example.org.