$347. This is the average out-of-pocket cost of sexual assault survivors who received forensic examination services as part of a rape kit from 2016 to 2018, Kaiser Family Foundation established.

Under federal law, they shouldn’t have to pay anything at all.

Violence Against Women Act (VAWA) — Reauthorize Last month as part of an omnibus spending bill in Congress — need States cover all out-of-pocket costs for forensic examinations get federal funding Applies to law enforcement agencies, courts, and victim services.Even if victims are later fully reimbursed, states that allow hospitals to bill patients still violate Require The Justice Department arranged for them to use the funds.

But not everyone who interacts with survivors, including hospital and emergency department staff, knows this. As a result, a patchwork of state laws and a nationwide shortage of examiners who are specially trained and understand trauma has resulted in sexual assault survivors often being charged for forensic examinations that should be free, experts told the 19th.

This is an additional burden for those already dealing with not only the trauma of the attack, but the possible impact of seeking help.

After being raped or sexually assaulted, survivors can claim rape kit take an exam. The process often requires getting medical care or getting evidence from the police, and it usually allows the survivor to talk to someone about what happened. Survivors can refuse any part of the test, including genital swabs.

Jen McNew, a forensic nurse consultant in Maryland, said having survivors take control of the exam is critical to the recovery process.

“Their bodies were the scene of the crime, and obviously evidence had to be collected,” McNew said.

After survivors may relive the trauma they just experienced during the forensic examination, they may also — unexpectedly — pay for it.

From 2016 to 2018, when previous versions of VAWA were in place, two-thirds of privately insured women in the U.S. received rape kits for out-of-pocket forensic examination services, Kaiser Family Foundation (KFF) last month reported an analysis of policy and coverage gaps based on the National Claims Database of people in large employer plans.

“If you’re going to get VAWA funding, which all states do and they really want, you have to meet these specific guidelines,” said Ilse Knecht, director of policy and advocacy for the Joyful Heart Foundation, which leads the group. Activity End the rape kit backlog.

Not a Modern Healthcare subscriber? Register today.

Barbara Sheaffer, medical advocacy coordinator for the Pennsylvania Coalition Against Rape (PCAR), said the bill may have been ignored, or survivors may not have realized what it was. When a survivor receives unexpected medical bills after being assaulted, they may simply not have the emotional capacity to deal with what else they’re going through, she said.

“I’ve dealt with situations where payment isn’t received and then it’s sent to collection centers. It’s very challenging to try to correct that,” said Sheaffer, who works with sexual assault nurse reviewers and advocates at rape crisis centers across the state .

Experts told the 19th that the national shortage of Sexual Assault Nurse Examiners, also known as SANEs, is a key part of the bill survivors are being left with that they shouldn’t pay. SANEs are nurses trained to work with sexual assault survivors, often the most qualified to administer rape kits in hospitals — and actually know how to navigate the billing process to prevent survivors from being charged.

“We facilitate the process when they’re here,” said McNew, who has been a SANE practitioner since 2005. “But there are a lot of hospitals that don’t have forensic nurses.”

Knecht said the unexpected billing she had worked at the National Center for Victims of Crime as early as 2005 boiled down to training and policy issues within the hospital: People in the billing department didn’t know what they were doing when they were supposed to, and the hospital The policy has not been made clear to staff.

The KFF analysis agrees on the possibility that hospital billing services are not always aware of the law, and also points to a lack of sanity as a possible reason for survivors being billed — especially since the state may not recognize that providers of medical forensic exams are not Certified SANE.

DOJ Office of Violence against Women, which oversees VAWA-authorized grant programs, states recommended Receive federal funding under medical provider law Do Specialized sexual assault forensic training is required to conduct rape pack inspections, although states can determine what that training should be.

In its analysis, KFF argues that the norm means states are not obligated to conduct forensic examinations if they are not conducted by SANE or a similarly licensed medical professional.

A shortage of SANEs can also place additional financial burdens on survivors.

Teresa Stafford, executive director of the Ohio State Hope and Recovery Survivor Resource Center, which operates a rape crisis center and houses battered women in Summit and Medina counties So — say, in her area, survivors are burdened with transportation costs to get to SANE. In rural Ashtabula, Ohio, some survivors need to travel to hospitals two counties away to get to SANE, she said Find someone who is eligible to be examined in a rape pack.

“If someone wasn’t trained, they would read step-by-step out-of-the-box instructions. In any other situation, you wouldn’t be comfortable with someone giving you this type of medical treatment, so survivors deserve better treatment,” she said.

State’s Victim Compensation Assistance is sometimes billed correctly even after SANE checks, Sheaffer said programPatients can still receive a doctor’s bill after the day’s doctor’s examination.

“It’s not allowed, but it’s happening,” she said.

While some states have tried to clean up the process to prevent victims from footing the bill, the end result has been inconsistent patchwork quilt laws, Knecht said.

“There are definitely these little quirks that still put victims on the bill, even when they shouldn’t,” Knecht said.

Alina Salganicoff, KFF’s senior vice president and director of women’s affairs, said when considering all the burdens victims face, in addition to forensic examinations, it’s important to keep in mind the larger health care “gray area” that victims of sexual assault face. health policy.

Survivors often have to pay for other forms of medical care during their hospital visits. Most states don’t cover these extra services — like X-rays, pregnancy tests, MRIs, STI testing, prescriptions, ambulance fees, and extra doctor visits. In addition to placing an additional financial burden on survivors, the allegations endanger them.

When a charge appears on survivors’ insurance or is mailed to their home, the hospital may alert the victim’s attacker that they are simply seeking help.

Stafford said she had seen this before, when the perpetrator shared insurance with the victim.

“We know that a lot of times people are sexually assaulted, and they are often sexually assaulted by someone they know, love and trust, and that person may be right in their family,” she said.

Amrutha Ramaswamy, who led the KFF analysis and provided policy research services to the group as a consultant, said the costs incurred by the survivors examined in this study were just one example of the general lack of support for victims.

“When I was working on the hotline, I didn’t know people could pay for rape packages out of their own pocket. I didn’t even think about it,” she said. “That’s something you probably didn’t know.”

RAINN — the Rape, Abuse and Incest National Network — said in an emailed statement that survivors who face many barriers to entry into the criminal justice system “should never pay for sexual assault nurse examinations and associated treatment.”

The group also noted resource On its website on sexual assault forensic examinations and handling of the criminal justice system. The Justice Department had no immediate comment when asked about the forensic examinations that would cost victims out-of-pocket costs.

Originally Posted by 19th

If you or a loved one has been sexually assaulted and is in crisis, call the RAINN (Rape, Abuse and Incest National Network) hotline at 1-800-656-4673 or 24 hours chat service at rainn.org.