Rape victims in U.S. made to pay part of the medical bill

(Reuters Health) - Women who have been sexually assaulted in the U.S. often bear some costs for testing and other medical treatment when they report the rape to authorities, according to a new study.

Victims with private insurance pay on average $950, or 14 percent, of the cost of medical services, and the insurance providers pay about $5,789, researchers found.

“With other violent crimes, victims are not responsible for paying for the damage that results from the crime,” lead author Ashley Tennessee told Reuters Health. “Many people know sexual assault is an issue, but they’re often unaware that victims have to pay for associated medical charges,” said Tennessee, of the Medical University of South Carolina in Charleston.

In 2013, insurance providers and victims paid more than $9 million for medical services related to sexual assault, the study authors write in the American Journal of Public Health. The average cost was $6,737 per case.

The Violence Against Women Act, passed in 1994 and reauthorized in 2013, requires states to pay for sexual assault forensic exams, known as “rape kits.” However, hospital billing procedures often include more services than those associated with the rape kit alone, and forensic costs also vary by state.

Tennessee and colleagues looked at hospital billing records for privately insured women in the U.S. who were victims of rape in 2013. They identified 1,355 assaults, with 98 percent of victims not admitted to the hospital. The 32 patients who were admitted to the hospital paid an average of $788 for their inpatient stay. The others paid an average of $316 for outpatient costs.

Of the group, about 7 percent filled a prescription for pain medication, antibiotics, HIV prevention drugs, emergency contraceptives or sleep or anxiety medication. These 214 victims spent an average of $48 to fill prescriptions.

Overall, about 88 percent of the 1,355 victims incurred charges on the day they visited the hospital, and 27 percent paid more than 25 percent of those costs. About 7 percent paid more than 50 percent of the cost. After visiting the hospital, about 63 percent of the patients incurred more charges up to a month after the incident, including prescriptions, further medical care and mental health services.

“This financial burden adds to the emotional burden of sexual assault,” Tennessee said. “This is an area that society has missed, and we have a moral right to help victims.”

A limitation of the study is that the data didn’t include men or LGBTQ victims of sexual assault. It also doesn’t account for publicly insured victims or homeless women who may face a greater risk for assault due to environmental and social factors related to poverty, the authors note.

“Follow-up studies must look at the prevalence in these groups,” Tennessee said. “We want victims to know they’re not alone in this journey and recovery process, and that includes studying and informing all groups about their access to funding resources.”

“We encourage all victims of sexual assault to get a medical exam following the incident. Anything that is a barrier to ensuring victims are physically OK is bad for them and the community,” said Scott Berkowitz, president and founder of the Rape, Abuse and Incest National Network (RAINN) in Washington, D.C. told Reuters Health.

“Congressional attention has been focused on making sure victims aren’t charged for the rape kit and forensic evidence, and there hasn’t been as much attention paid to making sure they aren’t charged for the other medical costs that result,” he told Reuters Health by email.

Tennessee and Berkowitz suggest emergency room personnel and hospital workers inform victims about charity funds that hospitals and states offer to reimburse those out-of-pocket costs. The Violence Against Women Act will be reauthorized next year, and RAINN and other sexual assault groups are urging lawmakers to update the funding definitions and mechanisms to cover additional costs.

“There are still too many barriers for victims and too many ways we discourage them from coming forward and reporting to police,” Berkowitz said. “Receiving a rape kit exam at a hospital is an important first step in reporting incidents to police.”

SOURCE: American Journal of Public Health, online April 20, 2017.