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Sentara's statement on "Medical Debt Ecosystem" report
Sentara is recognized nationally for our commitment to compassionate and responsible billing practices
The following statement is in response to the research study titled “Medical Debt Ecosystem: The Mechanized Wealth Extraction from America’s Patients” by Patient Rights Advocate (PRA), George Washington University Law School, and Stanford University's Clinical Excellence Research Center release on Thursday, March 26.
The research report fails to accurately reflect Sentara’s billing practices or our efforts to care for the communities we serve. This report is a clear example of selecting information that supports predetermined arguments, misconstruing data, and ignoring many of the facts around healthcare in Virginia as well as the complex nature of healthcare in general.
As the largest health system in Virginia, with 11 hospitals in the state and one in northeastern North Carolina, Sentara was the point of care for nearly 1.5 million unique patients last year alone. We provided $382 million in community benefits with $185 million in uncompensated care in 2025. Sentara hospitals are among best in the nation at serving patients and our communities, as noted by the Lown Institutes Hospital Index.
Sentara is recognized nationally for our commitment to compassionate and responsible billing practices with common-sense collection procedures, resulting in a more patient-centered and practical approach.
We use economic factors—including credit scores—to thoughtfully distinguish between those unable to pay and those able but unwilling, ensuring our actions are both fair and effective. In addition, Sentara uses presumptive eligibility tools and community-based criteria (e.g., Medicaid eligibility, homelessness, participation in assistance programs) to proactively identify patients who may qualify for financial assistance and reduce barriers to care. It’s important to note, Sentara does not charge interest on payment plans, nor do we garnish wages, seize savings, use collection agencies, or foreclose on property. Our goal is to support patients during difficult times—not add financial strain. This approach reflects our mission to serve communities with compassion and integrity in every aspect of care.
Our focus on thoughtful collection means we file fewer collection actions overall compared to the vast numbers we serve. When collection proceedings do occur, cases are more likely to settle before trial, often with manageable payment plans, reflecting our commitment to solutions over hardship. In fact, in 2024, our most recent year for which we have data, Sentara had less than .5 per every 1000 unique patient visits result in court cases.
As a not-for-profit health system, Sentara is committed to ensuring access to medically necessary care regardless of a patient’s ability to pay. We provide financial assistance programs designed to support patients based on income and financial need, including:
• Free care (100% write-off): Available to uninsured, self-pay, and insured patients with household income at or below 300% of the federal poverty level and less than $50,000 in available assets. For insured patients, this applies to any remaining balance after insurance payment.
• Reduced care (80% discount): Available to uninsured and self-pay patients with household income between 300% and 400% of the federal poverty level and less than $50,000 in available assets.
• Standard uninsured/self-pay discount: Patients above 400% of the federal poverty level are not eligible for financial assistance but receive a 50% discount on hospital gross charges.
• Catastrophic financial assistance: For patients with significant medical expenses relative to income, balances may be reduced to 25% of household income when obligations exceed 100% of income.
Statement:
The research report fails to accurately reflect Sentara’s billing practices or our efforts to care for the communities we serve. This report is a clear example of selecting information that supports predetermined arguments, misconstruing data, and ignoring many of the facts around healthcare in Virginia as well as the complex nature of healthcare in general.
As the largest health system in Virginia, with 11 hospitals in the state and one in northeastern North Carolina, Sentara was the point of care for nearly 1.5 million unique patients last year alone. We provided $382 million in community benefits with $185 million in uncompensated care in 2025. Sentara hospitals are among best in the nation at serving patients and our communities, as noted by the Lown Institutes Hospital Index.
Sentara is recognized nationally for our commitment to compassionate and responsible billing practices with common-sense collection procedures, resulting in a more patient-centered and practical approach.
We use economic factors—including credit scores—to thoughtfully distinguish between those unable to pay and those able but unwilling, ensuring our actions are both fair and effective. In addition, Sentara uses presumptive eligibility tools and community-based criteria (e.g., Medicaid eligibility, homelessness, participation in assistance programs) to proactively identify patients who may qualify for financial assistance and reduce barriers to care. It’s important to note, Sentara does not charge interest on payment plans, nor do we garnish wages, seize savings, use collection agencies, or foreclose on property. Our goal is to support patients during difficult times—not add financial strain. This approach reflects our mission to serve communities with compassion and integrity in every aspect of care.
Our focus on thoughtful collection means we file fewer collection actions overall compared to the vast numbers we serve. When collection proceedings do occur, cases are more likely to settle before trial, often with manageable payment plans, reflecting our commitment to solutions over hardship. In fact, in 2024, our most recent year for which we have data, Sentara had less than .5 per every 1000 unique patient visits result in court cases.
As a not-for-profit health system, Sentara is committed to ensuring access to medically necessary care regardless of a patient’s ability to pay. We provide financial assistance programs designed to support patients based on income and financial need, including:
• Free care (100% write-off): Available to uninsured, self-pay, and insured patients with household income at or below 300% of the federal poverty level and less than $50,000 in available assets. For insured patients, this applies to any remaining balance after insurance payment.
• Reduced care (80% discount): Available to uninsured and self-pay patients with household income between 300% and 400% of the federal poverty level and less than $50,000 in available assets.
• Standard uninsured/self-pay discount: Patients above 400% of the federal poverty level are not eligible for financial assistance but receive a 50% discount on hospital gross charges.
• Catastrophic financial assistance: For patients with significant medical expenses relative to income, balances may be reduced to 25% of household income when obligations exceed 100% of income.