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    Donations to victims raises questions about others outside the spotlight

    It was a gesture of generosity and concern for the community: Some of the state’s largest health insurers pledged on Tuesday to waive out-of-pocket medical costs for members who were hurt in the April 15 attack on the Boston Marathon, and hospitals promised to hold back patient bills.

    Kay Lazar and I reported in today’s Globe that Tufts Health Plan would waive out-of-pocket costs for all medical and mental health needs resulting from the bombing and subsequent manhunt. Blue Cross Blue Shield of Massachusetts said it would review each case individually, and Harvard Pilgrim Health Care said it would waive medical costs.

    Several hospitals said they had removed victims from an automated billing system and would look to donations to cover those charges not paid for by insurance.


    But, what does it mean for the American health system that similar assistance isn’t always offered to patients injured by gunfire, other acts of violence, or accidents?

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    “This is the right thing to do,” Austin Frakt, a health economist with the Department of Veterans Affairs and Boston University, said of the assistance offered to the victims. “The whole country is focused on [the Marathon attack] and so that probably helps the hospitals and insurers recognize that it’s the right thing to do. When everyone is not looking so carefully, are they making the same choice?”

    State assistance programs and hospital charity help some patients who face large medical bills they can’t afford. Others deal with debt collectors.

    For those that have health insurance coverage but may still face high medical bills, “unlike with the events of last week, a plan may not be aware if their member has been involved in a catastrophic event,” said Eric Linzer, spokesman for the Massachusetts Association of Health Plans.

    When plans are notified by family or a provider, they work with members “on a case-by-case basis,” he said.


    Frakt said the variability in how such cases are handled is an argument for expanding health insurance coverage so that everyone is covered at least for catastrophic care.

    “Most of us want to live in a society that helps people in that circumstance,” he said. “Right now, we don’t do that systematically.”

    Chelsea Conaboy can be reached at Follow her on Twitter @cconaboy.