PATIENTS BEWARE: HOSPITALS WANT CASH UP FRONT BEFORE YOU CAN GET SURGERY!!!!!!!!!!!!
A growing number of debt-burdened hospitals are demanding payment before treatment
Posted: July 23, 2010
Giovinazzo was 57 and employed but uninsured when five months of
bleeding finally sent her to a doctor earlier this year. The
gynecologist wanted $620 before seeing her; a reading of the lab
results ($88) showed stage one uterine cancer.
The doctor referred Giovinazzo to a specialist at the M.D. Anderson
Cancer Center in Orlando, who said he would schedule surgery as soon as
she could pay half the estimated $10,000 to $50,000 cost. Giovinazzo,
of Dunedin, Fla., would not have been treated but for a stroke of luck:
She had a connection who was a friend of Anderson's chief operating
officer. She found out her bills would be covered as "charity care,"
which is doled out on a case-by-case basis.
For years, medical facilities have asked patients to hand over their
insurance copayments—normally $10 to $25 per visit—when they sign in.
But recently the business office has gotten more demanding. Many
institutions, facing a growing mountain of bad debt, are no longer
willing to take it on faith that the bills will eventually be paid and
are demanding up-front payments in elective or nonemergency situations.
"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 Ron Luke, a consultant to healthcare providers in more
than 25 states. Among them are Inova Fairfax in Northern Virginia and North Shore
in Manhasset, N.Y. Insured workers, too, are feeling the pain, as many
are choosing high-deductible plans, and copays and coinsurance charges
just keep going up.
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. Charles E. Grassley (R-Iowa), a vocal critic of such
practices. "It's another thing to charge patients up front...or even
withhold treatment until they produce a check. This is like applying
the principles of home or car sales to nonprofit health care."
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 $260 billion that went to
uncompensated care between 1999 and 2008, the desire for up-front
payment won't go away quickly, experts say. Indeed, a whole industry
has sprung up to advise institutions on how best to collect. "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 $299. "Your staff need to understand how to have
conversations about money and learn how to manage patients' responses."
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 Clint Wolcott, 54, a Labor Department lawyer from Bethesda, Md.,
who was told when he scheduled carpal tunnel surgery at the Surgery
Center of Maryland this spring to bring along a credit card to pay
$225, his share of the center's fee under his insurance. 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 Charles
Cohen, a vice president of operations for Ambulatory Surgical Centers
of America, which owns 25 percent of the Maryland facility. "It's like
any other business. Once the patient walks out the door, your chance of
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 Gerard Anderson, director of the Johns Hopkins University
Center for Hospital Finance and Management. "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.
Corrected on 8/4/2010:
A previous version of this story included Cedars-Sinai among hospitals
requiring payment up front for all nonemergency treatment and elective
procedures. The hospital does so only in narrow circumstances: elective
cosmetic surgery and foreign patients traveling to the United States
NO SURGERY, IF YOU DON'T HAVE YOUR PORTION OF THE MONEY, UP FRONT
My grandson has a small health insurance, he has already used up his 5 visits a year limit.
He has had bad tonsils and sinuses for over a year now, they
wanted to do surgery. We had him set up, only to find out he has to
first come up with 4000.00 to the hospital before this could happen.
Now you would think they would except the insurance portion and let him
make payments, ( not so ).We have tried other ways, like trying to put
him on medicare, since he is a student. Every thing we have tried so
far has not worked, I guess we are not needy enough. Now, i have to
ask, who the heck has 4000.00 up front?
I feel just having a small insurance plan would be proof enough that we are willing to make payments.
How is it that we are citizens 100 per cent in the good old
U.S.A. AND THE ONES HERE ILLEGAL GET free help, with ever thing and pay
no taxes?????????????? This is a disgrace and the most inhumane thing
American people are having to indure. Not fair!!!!!!!!!!!!!!!!!1
Oct 16, 2010 12:16:13 PM
The people who work pay the price
is crazy! I live on a fixed income and a single parent, so if my kids
get sick and need surgery and the damn bill is 30,000 dollars your
expecting my 20% now? As long as I make payments like I always have
because im not rich whats the big deal? Someone needs to look at this
matter and fix it now!
Aug 24, 2010 18:49:05 PM
Not clear yet
So , I'm not clear yet about one thing:
If I got to the ER with an very acute lower abdominal pain.
After triage and treatment ER Doctor decide that i need to be Admited
becasue I have renal calculus, I need to pay in front to be admitted?.
Can the hospital denied treatment because in that moment i don't have
any credit card, check with me?
Aug 04, 2010 15:23:02 PM
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