Patients Beware: Hospitals Increasing Requiring Cash Up Front
Eugene L. Meyer
For years, medical facilities have asked patients to hand over their insurance copayments--normally
"Large majorities of hospitals have organized their admission process where they want to see a check or credit card before they take you to your room," says
Since the tax-exempt status of nonprofit hospitals hinges on their providing charity care, how and what they charge the needy has brought congressional scrutiny.
"It's one thing to charge underinsured or uninsured patients more than insured patients for the same service," says Sen.
Full disclosure of how much hospitals spend on charity care, which will be required starting next year, may put pressure on administrators to back down a bit. But given the
"Hospital executives across the country agree that upfront cash collections are the most immediate fix to improve the revenue cycle," says a website promotion for Managing Upfront Collections: Strategies for Effective Cash Collections, a DVD offered for
Under a 1986 federal law, hospitals cannot make payment a prerequisite for emergency room care, but that's as far as patient protection goes.
"I was a little surprised to have to pay up front," says
According to the center's website, copayments, coinsurance, and deductibles are due the day of the procedure. Those signing up for cosmetic surgery must pay the total estimated cost then, and uninsured patients must pay in full beforehand.
"We always try to collect up front," says
The pain would be lessened if consumers could shop around for the best deal, but medical charges can be almost impossible to discern. Even if hospitals and doctors posted their charges for a coronary bypass or a hip replacement, say, you couldn't effectively comparison shop, says
"You don't know how many minutes (you'll be) on the operating table or if you'll need an MRI or CT, or how long you're going to stay, or who's making the decision." Some websites do provide general comparisons, and at least 38 states post some form of pricing information.
The Healthcare Blue Book says it uses billing and payment data to offer consumers a way to "determine fair prices in your area," usually the average providers accept from insurers for given procedures. Consumer Health Ratings allows patients to compare charges by facility and location, and links to sites that offer price comparisons in a number of states.
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