Imagine a friend has been sexually assaulted or raped. Immediately after the attack, she visits a hospital to have a rape kit collected. It takes hours for the nurse to examine her body, all while she retells the horrific event. It’s a night she doesn’t want to remember, but can’t seem to forget. Then, 6 months later when her body may be healed but her mind isn’t, she gets a call from an unknown number: a debt collector for the hospital, requesting back payment for when she received care after her rape.
A bill filed Tuesday in the North Carolina House seeks to address this situation by imposing a fine of $25,000 to hospitals that directly bill patients for their forensic medical exams.
Under current state and federal laws, rape victims are not supposed to be billed for their exams. However, some hospitals do it anyway, or end up billing for “associated” procedures or exams, leaving rape victims with a debt they didn’t think to consider after the most traumatic experience of their lives.
North Carolina’s Rape Victims Assistance Program currently offers hospitals up to $800 for a forensic medical examination: $350 for physician or SANE nurse, $250 hospital/facility fee and $200 for other expenses. The state-operated program specifically instructs medical facilities and providers to refrain from billing the victim.
Sponsored by Edward Goodwin (R) and Billy Richardson (D), House Bill 626 seeks to penalize hospitals, facilities and providers that circumvent the Rape Victims Assistance Program. The bill proposes a $25,000 penalty to a medical facility or provider each time they bill a rape victim, the victim's insurance, Medicaid, Medicare or any other source for the provided forensic medical examination. The bill defines “forensic medical examination” the same way the Department of Justice does.
“The examination should include at a minimum: (i) Gathering information from the patient for the forensic medical history; (ii) Head-to-toe examination of the patient; (iii) Documentation of biological and physical findings; and (iv) Collection of evidence from the patient. Any costs associated with the items listed, such as equipment or supplies, are considered part of the ‘forensic medical examination,” reads the Code of Federal Regulations.
While some hospitals may be choosing to bill victims directly, others have said they have no choice since $800 is not nearly enough to cover a full forensic medical examination, as it is described above. And what about the other aspects of the victim’s hospital visit? The N.C. House Bill and federal definition only cover additional procedures sometimes—and those times are not clearly defined.
“The inclusion of additional procedures (e.g., testing for sexually transmitted diseases) may be determined by the State, Indian tribal government, or unit of local government in accordance with its current laws, policies, and practices,” reads the Code of Federal Regulations.
So, is a victim responsible for the payment of pills related to the prevention of pregnancy and/or sexually transmitted diseases? What if the victim needs X-rays and a cast as the perpetrator broke her arm during the attack—would the X-ray “equipment and supplies” be considered part of the overall forensic medical examination?
House Bill 626 is a leap forward for victims of rape and sexual assault in North Carolina, like this Duke University student; but, it’s default to the federal definition of forensic medical exams could leave it open to more questions, confusion and loopholes.