Access Issues Involving Payment for Evidentiary Exams
When a sexual assault victim presents to a hospital or clinic, medical staff will typically assess and respond to serious or life-threatening injuries. However, the decision to do a formal evidentiary examination is dependent on the patient who must give written consent, and is affected both by State laws and the judgment of local law enforcement officials or prosecutors as to whether an examination will be useful and can be justified.
Numerous Federal and State laws have been enacted to ensure that victims of sexual assault do not have to pay for medical evidentiary examinations. However, some States limit payment only to victims who are willing to report the assault to police and/or to cooperate in any prosecution. If the assault is not reported, or the case is not prosecuted, the victim may be unable to obtain a full examination, or may have to pay for the costs of an examination.
A number of States place responsibility for payment on the county where the sexual offense occurred, or on the entity who requests the examination, most often the investigating law enforcement agency or the prosecuting attorney. If the county official, police officer, or prosecutor is told that the victim does not plan to formally report the assault (a decision that the victim may not want or be able to make immediately, and a decision which sometimes changes), they may not approve payment for an examination. Similarly, if they believe that the victim's account is weak or that successful prosecution is unlikely, they may act to preserve limited resources and not provide approval for payment.
Even when State laws mandate that victims not be charged for the expense of evidentiary exams, there are cases in which claims may be submitted to third party insurance companies, compromising the victims' privacy, as insurance companies may not only be informed of the sexual assault but may also learn about exposure to HIV or other aspects of treatment that could affect insurance coverage in the future. Victims may also be forced to disclose the assault to the primary person on the insurance, such as a family member or even an employer.
Victims of crime are not generally required to cover the costs of evidence collection incurred in the investigation of their cases. Despite the fact that most States have laws that designate payment sources to cover the costs of forensic exams for sexual assault victims, and some even specifically prohibit billing of victims, billing of sexual assault victims continues to be widespread (National Center for Victims of Crime, 2003; National Center for Victims of Crime, 2001). Victims need to be informed of their rights and of avenues of recourse when rights are violated.
