Join us for a session on online and flexible course options at LFCC, online transfer opportunities through ODUOnline. and credit for work and military experience.
Registration is required. Visit lfcc.edu/info to save your seat.
Shattered dreams and bills in the millions: losing a baby in America
The day after his 8-month-old baby died, Kingsley Raspe opened the mail and found he had been sent to collections for her care.
That notice involved a paltry sum, $26.50 — absurd, really, given he’d previously been told he owed $2.5 million for treatment of his newborn’s congenital heart defect and other disorders.
Raspe and his wife, Maddie, had endured watching doctors crack open the chest of their pigtailed daughter, Sterling, whom they called “sweet Sterly gurl.” The health team performed so many other procedures. But it couldn’t keep her — or her parents’ dreams for her — alive.
The bills lived on for them, as they do for many other families of premature and very sick infants who don’t survive.
“What a lasting tribute to the entire experience,” Kingsley said angrily. “The process was just so heartless.”
More than 300,000 U.S. families have infants who require advanced medical attention in newborn intensive care units every year. Some babies stay for months, quickly generating astronomical fees for highly specialized surgeries and round-the-clock care. The services are delivered, and in U.S. health care, billing follows. But for the smaller fraction of families whose children die, the burden can be too much to bear.
A patchwork of convoluted Medicaid-qualification rules seek to defray these kinds of bills for very sick children. But policies differ in each state, and many parents — especially those, like the Raspes, who have commercial insurance — don’t know to apply or think they won’t qualify.
Also, because many crises that befall premature or very sick babies are in-the-moment emergencies, there may not be time for the preapprovals that insurers often require for expensive interventions. That leaves parents in crisis — or in mourning — tasked with fighting with insurers to have treatment covered.
Three families detailed for KHN how medical bills compounded their suffering during a time when they were just trying to process their loss.
As the hospital in Reno, Nevada was converting a parking garage into a COVID-19 unit in November 2020, Bennett Markow came into the world four months early. He weighed less than a pound. His care team loved to sing “Bennie and the Jets” to him as a nod to the jet ventilator keeping his tiny lungs working.
On Jan. 20, 2021, when Bennett was 2 months old, his parents were told he needed to go to UC Davis Children’s Hospital in Sacramento, California, for specialized care that could keep him from going blind. The transfer team would be there in an hour. And the Nevada care team said that because it was an emergency, the family needn’t worry about their insurance or the method of transportation.
Bennett’s eye problem ended up being less severe than the doctors had feared. And Crissa Markow and her husband, A.J., were billed for the plane ride from REACH Air Medical Services, which turned out to be out of network. Jason Sorrick, vice president of government relations for REACH’s parent company, Global Medical Response, said the ride happened during a “lapse” in Bennett’s Medicaid coverage.
The Markows said there was no lapse. They hadn’t applied yet because they thought they wouldn’t qualify — the family is middle-class, and Bennett was on Crissa’s insurance. They did not know they should until a social worker at UC Davis gave them more information — after the flight.
Crissa Markow said her heart dropped to her toes when she realized she was being billed over $71,000, more than she makes in a year as a social worker. (The No Surprises Act, which aims to eliminate surprise billing, could have prevented some of the family’s headaches — but Bennett was born before it went into effect this year.)
Although Crissa was used to working toward solutions, the billing quagmires she found herself in while juggling Bennett’s care, her job, her other son, and the travel logistics to stay with Bennett about 2½ hours away from her home were overwhelming. Crissa estimates she spent six to eight hours a week dealing with medical bills to keep them from being sent to collections — which still happened.
Bennett died last July after doctors said his lungs could not fight anymore. The Markows spent their bereavement leave battling with insurers and other billing agencies.
Finally, Crissa called REACH, the air transport company, and said: “Look, my son died. I just want to be able to grieve, I want to focus on that. Dealing with this bill is traumatic. It’s a reminder every day I shouldn’t have to be fighting this.”
By October, the Markows had settled the bill with REACH on the condition that they not disclose the terms. Sorrick said that the company reaches agreements based on the financial and personal situations of each patient and their family and that the company’s patient advocates had talked to Crissa Markow 17 times.
“If every settlement amount was disclosed publicly, then those rates become the expectation of all patients and insurance providers,” Sorrick said. “Ultimately, that would lead to all patients wanting to pay below cost, making our services unsustainable.”
Crissa Markow’s employer-provided insurance paid $6.5 million for Bennett’s care, not including what was covered by Medicaid. The Markows paid roughly $6,500 out-of-pocket to hospitals and doctors on top of their REACH settlement. But it was not those amounts — which the couple would have happily paid to save their son — but the endless harassment and the hours spent on the phone that haunt them.
“I just wanted to be with Bennett; that’s all I wanted to do,” Crissa Markow said. “And I just spent hours on these phone calls.”
Jack Shickel was born with stunning silver hair and hypoplastic left heart syndrome. Even though he was surrounded by wires and tubes, the nurses at UVA Children’s Hospital would whisper to Jessica and her husband, Isaac, that they had a truly “cute” baby.
But his congenital disorder meant the left side of his heart never fully developed. Each year in the U.S., over a thousand babies are born with the syndrome.
After two surgeries, Jack’s heart could not pump enough blood on its own. He made it 35 days.
Weeks after his death, when the Shickels were trying to muddle through life without him in Harrisonburg, Virginia, they called the hospital billing department about two confusing bills. They were then told the full cost of his care was $3.4 million.
“I laughed and then cried,” Jessica said. “He was worth every penny to us, but that’s basically $100,000 a day.”
Bills from out-of-network labs and other prior approval notifications continued to overwhelm their mailbox. Eventually, they figured out how to get Medicaid. The Shickels ended up paying only $470.26.
Jessica got the final bills in March, seven months after Jack’s death.
She noted that all of this was happening as the University of Virginia Health System said it was rolling back its aggressive billing practices after a KHN investigation found the prestigious university hospital was putting liens on people’s homes to recoup medical debt.
UVA Health spokesperson Eric Swensen expressed condolences to the Shickel family and added that the health system works to help patients navigate the “complex process” of evaluating financial assistance, including Medicaid coverage.
After KHN reached out for comment, the Shickels got a call from UVA saying that the hospital was refunding their payment.
The hospital care team had given the family a pamphlet about what to do when grieving, but a more useful one, Jessica said, would have been titled “How Do You Deal With Medical Bills After Your Child Has Died?”
Kingsley Raspe likes to say Sterling was “one special little lady” — not only did she have the same congenital heart defect as Jack Shickel, but she was also diagnosed with Kabuki syndrome, a rare disorder that can severely affect development. Sterling also had hearing loss, spinal cord issues, and a compromised immune system.
An explanation of benefits from the Raspes’ commercial insurance indicated the couple would need to pay $2.5 million for Sterling’s care — an amount so large the numbers didn’t all fit in the column. Even Kingsley’s suspicion that the $2.5 million charge was likely erroneous — in large part or in whole — didn’t erase the sheer panic he felt when he saw the number.
A computer programmer making $90,000 a year, Kingsley had decent insurance. He frantically Googled “medical bankruptcy.”
Sterling had been denied Medicaid, which is available to children with complex medical problems in some states. Kingsley had filed an application for the government insurance, which had to be submitted by mail from the family home in Gary, Indiana. In doing so, he broke the strict protocols on COVID exposure set early in the pandemic at the Ronald McDonald charity house near the Illinois hospital where Sterling was being treated and jeopardized his ability to stay there.
In rejecting the application, Indiana cited an income threshold and other technical reasons.
Everyone kept telling Kingsley and Maddie to get divorced so Sterling would qualify for Medicaid. But that wasn’t an option for Kingsley, a British citizen who is in the U.S. on a green card after meeting Maddie on Tinder.
Ultimately, Kingsley’s insurer revised the faulty notice that he owed $2.5 million. The family was told the mistake had occurred because Sterling’s initial hospital stay and surgeries had not been preapproved, although Kingsley said the heart defect was discovered halfway through the pregnancy, making surgery inevitable.
Throughout Sterling’s life, Kingsley did his programming job at his daughter’s bedside, in her hospital room. As a web developer, he created visualizations that break down Sterling’s expensive care — it helped him make sense of it all. But he cries when he remembers those days.
He hates that Sterling’s life can be reduced to a 2-inch stack of printed-out medical bills and the phone calls he still must endure from errant billers.
Despite receiving a plethora of other bills in the tens of thousands, he and his wife eventually paid their $4,000 deductible, along with a smattering of smaller charges and fees for equipment rentals that weren’t covered. In April, Maddie gave birth to a son, Wren, and Kingsley said he knows Sterling served as her brother’s guardian angel.
“My daughter passed away. I’m not unscathed, but I’m not in financial ruin. The same can’t be said for every family,” he said. “How lucky am I? I went through the worst thing imaginable, and I consider myself lucky — what kind of weird, messed-up logic is that?”
Navigating the NICU
Contact your insurance company to talk through your NICU stay costs, including what is covered and what is not. If your baby’s not already on your plan, make sure to add them.
Speak to a social worker immediately about applying for Medicaid or the Supplemental Security Income program, known as SSI. If your child qualifies, it can dramatically reduce your personal cost for a child with extensive medical bills.
The March of Dimes offers a “My NICU Baby” app designed to help you wade through the overwhelming experience. The nonprofit says the app can help you learn about caring for your baby in the NICU and at home, as well as monitor your baby’s progress, manage your own health, and keep track of your to-do list and questions.
If particular insurers or bills are confusing, reach out to your state insurance office. All states offer consumer support, and some states have dedicated advocates who can help you.
Kingsley Raspe also compiled advice for other families navigating neonatal intensive care unit stays for their babies.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Subscribe to KHN’s free Morning Briefing.
by Lauren Weber, Virginia Mercury
Virginia Mercury is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Virginia Mercury maintains editorial independence. Contact Editor Sarah Vogelsong for questions: email@example.com. Follow Virginia Mercury on Facebook and Twitter.
Laurel Ridge hosted College Night at Fauquier Campus
Hundreds of high school students came to Laurel Ridge Community College’s Fauquier Campus Tuesday night for the return of College Night following a two-year hiatus brought on by the pandemic.
Students from high schools in Fauquier County, Rappahannock County and beyond were able to meet with representatives from more than 75 colleges and universities from around Virginia and the nation – including Laurel Ridge, of course – to learn about their programs, admission requirements, financial aid, scholarships and more.
“This is an exciting time in the lives of high schoolers, a time when they are figuring out what their next chapter will look like,” said Dr. Caroline Wood, associate vice president for student services and academic support at Laurel Ridge. “We are excited to be a key resource in their planning, and pride ourselves on being the college of choice for so many who are a part of this event.”
College Night is sponsored by the Virginia Association of Collegiate Registrars and Admissions Officers, and Laurel Ridge has been a part of it for more than a decade.
Colleges and programs represented included Bon Secours Memorial College of Nursing, Bridgewater College, Coastal Carolina University, Concord University, Embry-Riddle Aeronautical University, Florida Institute of Technology, George Mason University, Hollins University, Illinois Wesleyan University, Johnson & Wales University, Mount St. Mary’s University, Ohio University, Regent University, Roanoke College, Seton University, South Dakota School of Mines and Technology, University of Kentucky, University of Virginia, Virginia State University and Virginia Tech.
“It was great to have this event back on campus,” said Laurel Ridge student life and engagement coordinator Chris Lambert. “Our four-year partners are always eager and excited to register for this event. Not only were we able to invite potential future students back to our campus, but we were also able to show off our new STEM and health professions building, Hazel Hall.”
College Night is part of a six to eight-week college transfer tour. It was on the Middletown Campus Wednesday afternoon and in the Apple Blossom Mall Wednesday evening.
Supervisors approve Outdoor Sports Facility over recommendation of County Planning Commission, add to the Short-Term Tourist Rental count
The Warren County Board of Supervisors held a special meeting September 27th, largely to process a list of nine actions that were not able to be covered during the regular meeting on September 20.
The Board quickly approved two leases of county property, one for a property at 229 Stokes Airport Road to Skydive Front Royal, LLC, for $600 per month, and the other for an apartment at 136 Hillidge Street for $725 per month to Raymond K. Freeman. There were no public comments on either lease, and the Supervisors approved both unanimously.
After a lengthy public hearing, on a 3-2 margin, the Supervisors approved a Conditional Use Permit (CUP) for Cole and Danielle Haase for an outdoor sports facility on their property at 19959 Fort Valley Road. In July, the County Planning Commission held a public hearing and ultimately recommended denial of the permit, citing traffic and neighborhood concerns. Since that time, the applicants have downsized the proposal and worked to allay the concerns of the neighborhood. They intend that the majority of the activities will be inside and scaled back outdoor activities to daytime only. The Haases are also local business owners. The property was formerly used as a church and multi-activity center by Master’s Touch Ministries.
Public comment was brisk with 24 individuals either speaking in person, or submitting letters, e-mails, or videos. Eighteen were in favor of the permit and six against. Neighbors inveighed against possible traffic increases near an accident-prone intersection at Fort Valley Road and Route 55. Supporters praised the applicants’ commitment to youth sports, as an important factor in developing teamwork, athletic and social skills for young people. Sue Russell, whose property adjoins the site, opposed the permit and is worried about the effect of any groundwork or excavations resulting in flooding on her property.
Some of the supervisors recalled when outdoor concerts and events were held at that facility. Supervisor Vicky Cook appeared to be the leading opponent of the proposed permit, calling into question the applicant’s parking and traffic estimates. At the end of the discussion, Supervisor Oates offered a motion to approve, seconded by Supervisor Mabe, and the motion passed, 3-2. Chairman Cullers, joined by Supervisors Oates and Mabe, Aye, Supervisors Cook and Butler, No.
Michelle Moriarty is requesting a CUP for a short-term tourist rental for the property at 96 Cappy Road that she recently purchased in April of 2022. The applicant will use a local property manager and local professional services for emergencies, maintenance, cleaning, garbage disposal, and guest screening/reservations. There was one speaker who opposed the permit on the grounds that the area is residential, not business. However, the Virginia General Assembly and the courts system have specifically determined that short-term rentals are a residential activity, rather than a business operation. Under questioning by the board, the applicant indicated that she had already spoken with all the nearby property owners and provided contact information should any need arise.
Planning Director Wendling indicated that there had so far been no complaints or calls related to these properties. Supervisor Cook questioned whether the County Sheriff would necessarily know if there was a problem with a short-term rental. County Administrator Edwin Daley suggested that the County could investigate developing a registry list for approved short-term rentals to allow law enforcement in the Public Safety Communications Center to know who to contact if there was a problem. Finally, on a motion by Supervisor Oates, seconded by Supervisor Mabe, the Board unanimously approved the permit.
Kendra Hansen, Kathryn Stuart, Simon Sarver, and Michael Cherubin have applied for a CUP for for a Short-Term Tourist Rental Located at 97 River Overlook Road. The owners plan to use the property themselves throughout the year, but they would also like to be able to make the property available for short-term lodging for visitors of the Warren County area when they are not occupying it. The applicants will manage the property personally. There were no speakers for or against the application, and no discussion from the supervisors. On a motion by Supervisor Mabe, and seconded by Supervisor Cook, the motion passed unanimously.
CAZA Legacy, LLC has requested a CUP for short-term tourist rental for the property located at 241 Wildcat Drive. The applicants, Robert Chevez and Erin Kavanagh, purchased this residentially zoned property as an investment property and currently are renting the property long-term for over 30 days since purchasing it in February 2022. They do intend to also use it for themselves as a get-away from their homes in Northern Virginia. The applicants are requesting a waiver to the setback requirement of 100-feet from dwelling to dwelling. The dwelling to the west is 50 feet and the applicants submitted a letter from their neighbor giving his support of the application. The applicants will be contracting a local property management company to maintain the property and as realtors they will be marketing and managing the rental. The property was the subject of an approved permit for short-term tourist use in 2018, however the use was never established and that permit expired.
Two letters from neighboring property owners were submitted. One was in favor of the permit issuance, and one was opposed. There were no speakers at the public hearing, and on a motion by Supervisor Mabe, seconded by Supervisor Cook, the Supervisors voted unanimously to approve the permit.
Matthew Williams and Jay Gilbert have applied for a CUP for a short-term tourist rental located at 244 Delicious Road, Linden. The applicants plan to manage the property personally with assistance from local professional services for cleaning and landscaping. The closest dwelling unit is 115 feet to the northeast. There were no comments from the supervisors or the public. One letter supportive of the use was submitted. On a motion by Supervisor Oates, seconded by Supervisor Butler, the Board unanimously voted to approve.
Matthew Williams and Jay Gilbert have also applied for a CUP for a short-term tourist rental in an agriculturally-zoned property located at 115 Lonesome Flats Road. The applicants plan to manage the property personally with assistance from local professional services for cleaning and landscaping. The closest dwelling is 313 feet to the north. The planning department provided a letter by a neighbor, John Croft, who opposes the permit. Mr. Croft alleges that the Road is private, on his land, and has not granted permission to use it for guests. After a discussion regarding the legal status of an access easement to the applicant’s property, the supervisors decided to approve the permit, subject to verification that an access easement does exist. Supervisor Cook made a motion to approve, seconded by Supervisor Mabe. The vote to approve was unanimous.
Thomas Pigeon has applied for a CUP for a Short-Term Tourist Rental Located at 540 Lakeside Drive. The applicant will contract a local property management company, Shenandoah Valley Property Maintenance LLC, to manage and maintain the property if the use is approved. The owners plan to manage the rental of the property through Airbnb and will review any renters for a positive online ranking. All the required conditions for permitting are complete. On a motion by Supervisor Butler, Seconded by Supervisor Mabe, the Board voted 4-1 in favor of approval. Chairman Cullers expressed her concern and continued opposition to properties being purchased by owners with no connection to the area for this use.
The Meeting adjourned at 8:50 p.m.
Cities work to lure remote tech workers
Some tech workers are ditching San Francisco and other areas with high living costs and relocating to more affordable areas instead. And many cities are rolling out the red carpet, aiming to attract highly skilled workers, along with the knowledge and tax revenues they bring with them.
Many cities offer relocation bonuses and other perks to entice remote workers. Why should you choose Tulsa over Memphis? Well, for one, Tulsa could pay you $10,000 to move. The cities that are most aggressively courting remote workers have suffered contracting or slow-growing populations. By drawing in new workers, cities hope to grow their tax base and attract high-value industries, such as tech and engineering.
Tulsa is running one of the best-known programs, offering remote workers $10,000 grants and free access to co-working spaces. The local government also coordinates with other organizations to host events and to help newcomers feel welcomed. Since 2018, Tulsa Remote has drawn in over 1,200 remote workers.
Tulsa is far from alone. At least 70 cities and regions have set up similar programs. The Northwest Arkansas Council launched a Life Works Here initiative, also providing $10,000 grants. Tuscon, Arizona, provides $1,500 to cover relocation costs, plus other benefits. Meanwhile, Hamilton, Ohio, is offering STEM workers who relocate $10,000 that can be put towards paying off student loans.
Freelancing website UpWork estimates that 22 percent of the American workforce, over 36 million people, will be working remotely by 2025. An Owl Labs study found that 16 percent of companies are already fully remote globally. Even as offices open back up, the Pew Research Center has found that 61 percent of employees continue to work from home simply because they prefer to do so.
“My cat hates visitors!”
Does your cat run and hide every time someone comes over? Here are four steps to desensitize your feline to strangers.
1. Associate guests with something positive. For example, give your cat treats before visitors arrive and during their stay. At first, do this somewhere where your pet feels safe.
2. Over time, gradually lure your cat closer to your guests during their visit using its food bowl or treats.
3. Initially, ask your guests to ignore your cat if it approaches them.
4. Encourage your visitors to give your cat treats and play with it once it feels comfortable in their presence. Your cat will slowly understand that having guests over is fun.
Consult a feline behaviorist if you don’t see any improvement in your cat despite your best efforts.
Permaculture: farming inspired by nature
Unlike intensive agriculture, which destroys habitats, pollutes waterways, and decreases soil quality, permaculture aims to emulate natural ecosystems rather than trying to fight or control nature. Here’s what you need to know about this sustainable practice.
The permaculture principles were developed in the 1970s by Australians Bill Mollison and David Holmgren. They don’t solely focus on agriculture but on buildings, energy, and technology. Today, permaculture is a design approach that integrates land, people, and other resources to align with nature.
Permaculture is based on 12 principles, all focused on caring for the land and the people who live on it. These principles include observation, which aims to develop effective and intelligent strategies for each situation. Other principles include:
• Valuing renewable resources and services
• Zero waste
• Promoting modest solutions
• Incorporating diversity
In agriculture, permaculture practices focus on restoring soil health and fertility. In the garden, permaculture aims to maximize the use of water, sun, and other natural energies. Permaculture also involves building living spa¬ces with biodegradable and locally sourced materials with a low ecological footprint.
Permaculture aims to create productive ecosystems that are diverse, stable, and resilient. Supporting the companies that practice it supports everyone.