Even with health insurance, medical bills can mount for shooting victims

The January 2011 shooting spree that injured U.S. Rep. Gabrielle Giffords and a dozen others and killed six people is a stark reminder of the physical, emotional and financial toll of recovering from gunshot wounds. Even with health insurance, victims can be stuck with piles of out-of-pocket medical bills.

Hospitals will charge a total of nearly $2.4 million for treating the 13 people wounded in the Tucson, Ariz., shootings, according to an estimate by Ted Miller, a senior research scientist with the Pacific Institute for Research and Evaluation. He has tracked data about firearms injuries since 1985.

Once health insurance negotiations are factored in, total payments for injuries sustained in the Arizona shootings will be about $565,000, according to Miller. Typically, health insurance companies negotiate with hospitals on lower payments.

“There are so many different ways people can be treated for a firearm injury,” Miller says. “Some will suffer severe brain damage and be institutionalized for the rest of their lives, and others face long periods of rehab. Some are released within a few days.”

U.S. Rep. Gabrielle Giffords is undergoing rehabilitation after being critically injured during a shooting spree in Tucson, Ariz.

Depending on the extent of the injuries and the need for rehab, many shooting victims face a mountain of medical expenses — some of which will be paid by the victims themselves.

Health insurance coverage varies greatly, but for typical low-deductible plans, it’s common that once a patient meets the deductible, he’ll pay 20 percent of the expenses and the insurer will pick up 80 percent. A policyholder with a higher deductible might pitch in just 10 percent, or even less, once the deductible is met.

Typical medical bill for firearms injury tops $48,000

The medical costs of treating a firearm injury fluctuate widely, says Dr. Mark Reiter, who practices at St. Luke’s Hospital in Bethlehem, Pa., and is a member of the American Academy of Emergency Medicine.

A wound that grazes the skin can be treated in an emergency room for less than $1,000, Reiter says. But treating someone with more severe injuries requiring intensive care, surgery and potentially rehab easily can add up to hundreds of thousands of dollars, he says.

The majority of gunshot wounds affect areas like the arms and legs, Reiter says, rather than more dangerous regions such as the head or chest.

The average medical cost for a firearms injury is $48,610. In 2010, total U.S. medical costs associated with firearms injuries were estimated at $1.5 billion, according to Miller.

According to the National Center for Injury Prevention and Control, close to 100,000 people in America are shot or killed each year in gun incidents. Of those, about 32,000 are suicides.

The high costs of treating firearm injuries stem more from long-term care, such as rehabilitation services, than from acute care, such as a visit to an emergency room. U.S taxpayers cover some medical costs through Medicare and Medicaid, as well as through court proceedings associated with gun-related criminal cases. Employers also pay a share of the tab through sick leave, workplace disruption and health insurance price hikes.

One of the most expensive components of recovery from a gunshot wound is long-term rehabilitation at places like Houston’s TIRR Memorial Hermann Hospital, where U.S. Rep. Gabrielle Giffords is being treated.

Treatment of gunshot wounds ‘can bankrupt you’

David Works of Colorado Springs, Colo., was shot twice on Dec. 9, 2007, when gunman Matthew Murray opened firing at the New Life Church in Colorado Springs. Works spent nine days in a hospital recovering from bullet wounds to his stomach and leg. Two of his daughters died in the shooting. Aside from Works, four other people were injured in the shooting spree — which occurred in Colorado Springs and 65 miles away in Arvada, Colo. — and three other people were killed.

Works was whisked into surgery immediately. When he awoke, he learned that his daughter Stephanie, 18, had died in the church parking lot. His 16-year-old daughter, Rachel, died after undergoing several operations during a nine-hour span.

Works, a systems administrator for First Data, wanted to better understand the medical costs connected to the tragedy, so he created a spreadsheet listing medical expenses billed by doctors and the hospital as well as details of what was covered by health insurance.

However, he concedes his detailed spreadsheet isn’t accurate because he never received a final bill from the hospital. Because he was the victim of a high-profile shooting, financial support poured in from friends and strangers.

Many doctors didn’t charge him fully. The charges he did receive totaled $271,796 for his care and Rachel’s care. Her hospital bills were $164,525 for the nine hours of treatment.

His health insurance provider, UnitedHealthcare, paid $55,862 and he owed $2,942; his employer insisted on picking up what Works owed.

“Suppose I didn’t have insurance. How much would I have had to pay? If there’s a normal guy who doesn’t get shot in a high-profile way, he’s going to have to pay for everything. The bottom line is something like this can bankrupt you,” Works says.

David Works (center) was injured and two of his daughters — Rachel (left, back row) and Stephanie (right, front row) — were killed in a 2007 shooting at a Colorado church.

Once Works returned home from the hospital, he and his family battled the emotional scars of losing Stephanie and Rachel. The family attended therapy sessions every week for a year. Local groups, including the Colorado Springs church where the violence occurred, covered those costs.

Works hasn’t needed any long-term physical rehabilitation. He went back to work about six weeks after the shooting, but he does suffer memory lapses linked to the rampage.

“I forgot my boss’s name one day, and I’ve been there for 10 years,” Works says. “Trauma really affects the brain.”

What will my insurance cover?

Certainly, anyone who suffers a gunshot wound can lean on his health insurance, but that coverage usually won’t pay for everything. Furthermore, experts note that policyholders are seeing their out-of-pocket costs soar for an array of health care services, including treatment of firearms injuries.

Because consumers are being saddled with higher health insurance premiums, deductibles and co-pays, medical professionals recommend policyholders consider supplemental health insurance. That extra coverage can help offset the often steep costs of treating a firearms injury, such as a lengthy hospital stay.

Steven Beumer, owner of the National Benefit Service Center in Orlando, Fla., says he recently sold supplemental policies to a group of employees that cover medical costs up to $2,500 a year at a cost of $8 a week. This supplemental policy is meant to bridge the gap in coverage before a consumer’s traditional coverage kicks in. In this case, the traditional coverage has a $4,000 deductible.

Renee Guariglia, executive vice president of Falcone Associates in Syracuse, N.Y., offers medical coverage from Aflac that pays $100 to $200 daily for a hospital stay. The money is paid directly to the policyholder, not the health care provider. For someone 18 to 39 years old, an Aflac policy offering $200 a day in coverage would cost close to $40 a month, Guariglia says.

NASA astronaut Mark Kelly spends time in Tucson, Ariz., with his wife, U.S. Rep. Gabrielle Giffords, before she is transported to a hospital in Houston.

Consumers also can buy accident plans that cover firearms injuries, except those that are self-inflicted.
Guariglia offers an accident policy for someone age 18 to 39 that costs $5 a week, or $9 a week for a family. This accident policy supplies $120 for an emergency room visit, $50 for followup care, $200 for major diagnostic tests, $200 for a ground ambulance and $1,000 for a hospitalization within 24 hours of the accident.

Some insurance experts point out these supplemental plans can provide a cushion for cash-strapped consumers. But others argue that some of these plans aren’t a catch-all and are intended to cover expenses only under rare circumstances. Miller emphasizes that a small percentage of Americans are hospitalized each year.

“These policies are sold on emotion and are extraordinarily profitable. They’re a sucker line,” Miller says.

But insurance agent Cindy Holtzman of Marietta, Ga., is such a strong believer in supplemental policies that she’s bought six policies herself that cost a total of $57 a month. Her policies provide additional payments for hospital stays, outpatient treatments and home therapy. Those payouts are on top of traditional health insurance benefits.

“Having these policies makes me not worry so much,” Holtzman says. “That’s key right now for me.”

Tips for buying supplemental insurance

• Not all plans are the same. Some plans pay health care providers directly and others make payments directly to the policyholder.

• Be mindful of how likely you are to use one of these plans, Miller says. In terms of buying extra health insurance, “people get hooked on emotion,” Miller says.

• Make sure the plan is valid in your state, Guariglia says. “You really need to read the fine print,” she says. “Make sure they tell you specifically what the premium cost is.”

–Lisa Shidler