Doctors, Hospitals Say 'Show Me the Money' Before Treatment
Written by Editor   
Friday, December 16, 2016 12:00 AM

News Bite: With higher deductible insurance policies many in the healthcare industries are turning to prepayment.  Stats show that  while more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so.  Yet many patients feel “If I need medical care I should be able to get it without having to afford it up front."  Fifty-one percent of workers with insurance through their employer had a deductible of over $1,000 this year.


A 34-year-old single mother has uterine prolapse and needs a hysterectomy.  She and her 13-year-old son have health insurance through her job as an administrative assistant, but the plan has a deductible of $5,000 apiece, and her doctor said he won’t do the surgery until she prepays her share of the cost. His office estimates that will be as much as $2,500. She is also is worried that the hospital may demand its cut as well before the surgery can be performed. “I'm so angry," she said. “If I need medical care I should be able to get it without having to afford it up front."

At many doctors' offices and hospitals, a routine part of doing business these days is estimating patients' out-of-pocket payments and trying to collect it up front. Eyeing retailers’ practice of keeping credit card information on file, there's certainly been a movement by health care providers to store some of this information and be able to access it with patients' permission.  But there's a big difference between handing over a credit card to cover a $20 copayment versus suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient's credit limit. Doctors may refuse to dispense needed care before the payment is made, even as patient health hangs in the balance.

The strategy leaves patients financially vulnerable too. Once a charge is on a patient's credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer's commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as “point-of-service collections.  For providers, there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes.  But the practice leaves many patients resentful.

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.  Patients are essentially paying for their procedures up front.  It may not be a significant amount compared to their salary, but they don’t necessarily have it available at the time of service.  The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year.

Experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.  Under the federal Emergency Medical Treatment and Labor Act (EMTALA), a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it's not an emergency, however, those discussions can occur before treatment.


Source:  http://www.medscape.com/viewarticle/873126