If your hospital tells you they want 'cash up front', tell 'em to 'take a hike!'
From John Curry, May 20, 2014
Please pay first, more hospitals say
Columbus Dispatch, May 18, 2014
An OhioHealth registrar called Kelley Finan to pre-register her for her
scheduled outpatient arthroscopic knee surgery and verify her insurance policy.
Then the woman told Finan that she owed $1,365.16 out of pocket for the
procedure.
“How would you like to pay for that today?” Finan recalled the woman
asking. “We take credit cards or debit cards.”
Finan, 54, of Grandview Heights, said she refused to pay upfront, and the
OhioHealth representative backed off.
“She never indicated her demand for payment was a ‘suggestion’ until I
called her out on it,” Finan said.
Increasingly, local hospitals are requesting not only co-pays upfront but
also deductibles and co-insurance, which is the patient’s share of the cost of a
covered health-care service beyond the deductible.
Officials with all local hospitals that request payment of deductibles and
co-insurance before a scheduled surgery or other health care said they don’t
deny patients care if they refuse to pay upfront.
“We’re not holding patients hostage,” said Keith Coleman, Mount Carmel
Health System’s chief financial officer.
On July 1, Ohio State University’s Wexner Medical Center will begin
requesting — but not requiring — that deductibles be paid upfront at all of its
locations where health-care services are scheduled in advance. The practice has
been used sporadically for two years by Wexner Medical Center, which has not yet
begun requesting co-insurance payments upfront.
Some other service providers, such as the travel industry, expect payment upfront, so it’s not unprecedented for the health-care industry to do the same, said Debra Lowe, the hospital’s administrative director of revenue cycle.
Some other service providers, such as the travel industry, expect payment upfront, so it’s not unprecedented for the health-care industry to do the same, said Debra Lowe, the hospital’s administrative director of revenue cycle.
“If your car needs replaced and you owe your $500 deductible (in an
insurance claim), it’s very clear that you need to pay that for services to be
rendered,” Lowe said.
Hospitals are taking such steps to head off the possibility of bad debt as
consumers see their deductibles balloon for employer-sponsored and individually
purchased health coverage. Among workers who are enrolled in health benefits
through their jobs, 15 percent had a deductible of at least $2,000 last year, up
from 3 percent in 2007, according to a survey by the Kaiser Family Foundation
and Health Research & Educational Trust.
In the fiscal year that ended June 30, Wexner Medical Center collected $3.6
million from patients upfront, primarily in co-pays and deductibles. That total
is expected to hit $4 million in the current fiscal year, which ends next month.
Local hospital systems recorded a combined $357 million in bad debt in
their most recent fiscal years, up 14 percent from a year earlier.
Larger deductibles appear to be more common with the advent of policies
available through the federal government’s new health-insurance exchanges, or
marketplaces, Lowe said. She said Ohio State already has seen at least three
patients whose policies purchased through Ohio’s federal exchange have
deductibles of at least $10,000.
More hospitals are testing and adopting the approach, said Elisabeth
Russell, the founder and president of the patient-advocacy consultancy Patient
Navigator. “It’s harder to collect money from someone after they’ve walked out
the door.”
With far more of patients’ own money at stake, it’s important that they
understand how much is owed, Russell said. But she said patients also can lose
leverage in their dealings with hospitals and other health-care providers if
they pay deductibles and co-pays upfront.
“I think they should, if possible, avoid paying upfront (in case) things
get messed up — as they usually do — in hospital bills,” Russell said.
At Wexner Medical Center, patients’ deductible payments are underestimated
to reduce the chance that a patient will be overcharged.
“The last thing we want to do is overcollect and then have to refund your
money,” Lowe said.
OhioHealth began collecting co-pays upfront from patients in 2008, and
deductibles and co-insurance in the past two years, said Jane Berkebile, system
vice president of revenue-cycle management.
In its most recent fiscal year, which ended in June, OhioHealth collected
$19 million from patients at the point of service, including co-pays,
deductibles and co-insurance, Berkebile said. The amount is increasing “as that
portion that’s due from the patient has grown.”
Mount Carmel, meanwhile, collects about $500,000 to $1 million upfront each
month from patients, said Karen Geisler, patient-financial-services consultant.
She said Mount Carmel has requested upfront payment from patients, including
deductibles and co-insurance, for about eight years.
Nationwide Children’s Hospital said it does not ask families of patients to
pay their deductibles before services are provided.
“If we did move to collecting deductibles prior to service, we have
financial counselors that would work with the family on other options,” the
hospital said in a prepared statement.
@BenSutherly
posted by Kathie Bracy at 3:43 PM
