judy ann 2010/10/16 16:19:30
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Patients Beware: Hospitals Are Increasingly Requiring Cash Up Front

A growing number of debt-burdened hospitals are demanding payment before treatment


Eugene L. Meyer

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.

Click here to find out more!

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.

[Health Reform Takes Aim at Hospital Readmission Rates]

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
collecting decreases."

[When a Hospital Is Bad for You]

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
for treatment.


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

[report comment]

william cochran

of GA
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!

[report comment]


of KY
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?

[report comment]


of FL
Aug 04, 2010 15:23:02 PM

Add a comment above

Top Opinion

  • technotrucker 2010/10/17 02:01:39
    Good for them. That will stop all the free medical care for the illegals in this country. The rest of us may have to suffer a bit for it, but I see it as a good think.

    Seek the truth, or remain a victim.

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  • dctravelerforworkandfun 2011/01/14 11:44:33
    I'm a landlord, I want my money up front before I let someone move into the house. I am having surgery and I have good insurance. INOVA Fairfax Hospital called me days before my surgery to secure the balance that my insurance would not cover. I put $100 on my credit card and I will pay within the 90 days in full with no interest the rest of the money. My mortgage company won't do that nor will my other creditors. I am happy to live near good medical care. Hospitals are a business. What decisions would you make if you ran a hospital? Remember, businesses look for profit. Where else will they get the money for new medial equipment?
  • mandy dctrave... 2011/05/16 01:39:14
    I understand what you are saying. I also understand they have programs for the disabled and poor. What about the middle class citizen? My husband is a Deputy Sheriff and we pay $785 a pay period for Blue Cross PPO for our family. Our co-pays are $40. I went to school to become a teacher and was laid off due to the economy in Ca. I have had severe abnormal uterine bleeding for over 1 month. The Dr. just made me pay $195 prior to surgery and now the hospital wants $485. Unfortunately,I will not be able to do the surgery or my family will starve. We do not live a high life. We live in a 1300 square foot home for a family of 4. Unfortunately, my savings is gone after being unemployed for a year. I have over 2000 applications out for employment. As far as I'm concerned the entire procedure shouldn't cost more than $800. The insurnace pays 80% yet they want my portion upfront. I guess I will have to wait and suffer until we can save the money or until I hemmorhage to death. The lady in the next room over from me was treated like a queen because she had medi-cal and they told her it would pay 100% for her surgery and she had a choice between two different hospitals. Wow we are being punished becuase my husband works.
  • Michaelene 2010/11/24 17:35:14
    My newest problem is finding a doctor that is accepting new patients.
    I cannot find a primary care doctor for my 19 year old who was released from her pediatrician last year. I cannot find a rheumatologist accepting new patients for either my son or myself.
    We live in an area with many great doctors and hospitals within minutes away.
    We have excellent and expensive health insurance but they didnt even ask.

    I had to pay my 20% upfront for my most recent proceedure even though I have already exceeded my out of pocket costs. One month later I received a full refund, thank God.
  • Vipor_GG 2010/10/23 20:34:45
    You know hospitals don't have bills to pay. And doctors and nurses have everything given to them so they don't need to get payed.

    People need to realize that although you have the right to life, liberty, and the pursuit of happiness your rights end where rights of someone else begins. You no more have the right to health services at the expense of another that you do a house or vehicle. Now if the doctor or hospital want to donate their services that is great, but charity by force isn't charity.
  • texasred 2010/10/22 20:12:09
    Welcome to the beginnings of Obamacare!
  • Isma'ila (God has heard)! 2010/10/22 19:29:24
    Isma'ila (God has heard)!
    That is so wrong! People have rights!
  • janet 2010/10/21 11:57:32
    Single payer is the only decent way to go. Insurance companies are just middle men who have become filthy rich off the backs of hard working Amerians.
  • judy ann janet 2010/10/21 15:16:44
    judy ann
    so true
  • ITALIAN... judy ann 2010/10/24 07:12:49

    October 24, 2010

    In This Issue:

    * EXPOSED: Mainstream Medicine's Deadliest Conspiracy
    * Outpatient Surgery Survival Guide
    * No Plunger? No Problem. Secret to Unplugging Your Toilet
    * Why It Pays to Use Your Credit Card
    * Drug-Free Diabetes Cure

    How well you recover from outpatient surgery is largely up to you. David Sherer, MD, author of Dr. David Sherer’s Hospital Survival Guide: 100+ Ways to Make Your Hospital Stay Safe and Comfortable, reveals what patients can do before outpatient surgery, and what to do once you get back home to improve healing and outcome.

    Should you pay for everything with cash, as some thrifty people do? Not necessarily -- Curtis Arnold, author of How You Can Profit from Credit Cards, explains why using your credit card can save money and time. Credit cards can also provide the best possible service if anything goes awry, Arnold explains.
    All the best,

    Jessica Kent
  • Sheila janet 2010/10/22 18:04:02
    Janet the insurance companies make less than 2% profits. They provide a service. Single payer is the doorway through wich the government gets to make EVERY CHOICE IN YOUR LIFE because then it WILL be their concern.
  • janet Sheila 2010/10/22 23:49:22
    The insurance companies pay their CEO's and shareholders alot more than necessary so if they can show only 2% profits that could be one reason, but I don't believe any of their bull. Insurance companies are not our friends.
  • Sheila janet 2010/10/26 15:41:18
    LOL, and we should trust the government? The insurance companies are a private business and if they do not offer a competitive and necessary product they go out of business. If the government runs a program that is NOT competitive and does NOT have a product we want of=r need they raise our taxes and pass laws to FORCE our compliance. See the difference????
  • janet Sheila 2010/10/27 15:28:32
    I think you are wrong on this. We are the government and we have the power to change what we don't like about it, if we would stop giving our power away to the rich people who do not care about us, the average Jo. If we were not so divided, we could change the government to our advantage.
  • Sheila janet 2010/10/27 17:19:58
    Janet 70% of the country did not want the healthcare bill passed and it did. You think we matter to the government?

    Look around the world at the systems in place and compare. yea, sure they may pay for somethings in other countries but compare the care. Consider the fact that the RICH of other countries COME HERE for care. Where do our rich go? Nowhere. they stay here (with the exception of "new" or expirimental procedures the FDA-a gov entity-- will not aprove here)
  • janet Sheila 2010/10/30 13:55:46
    Sheila I think your figures are wrong and I also believe that healthcare should be a right not a privilege. Some rich people in this country go elsewhere for healthcare, so what does any of that prove?
  • Sheila janet 2010/11/01 15:13:46
    sweetie the thing is something is not "made" a right. Rights are given by God and no one else. healthcare is a good/service and should be treated as such.
  • janet Sheila 2010/11/02 13:36:41
    So your god doesn't want you to have healthcare?
  • Sheila janet 2010/11/02 14:26:41
    Good Lord Janet.....that is a ridiculous statement now isn't it? Sure he does. Does he dictate it be free? LOL, no. What He wants has little to do with much in this day and age. But not once in the bible did I see the words "refer thy neighbor to the state building". He says WE should help each other. That is not a gov program.
  • janet Sheila 2010/11/02 15:58:05
    It was not a statement, it was a question, which you answered.
    You reference a book that is old, out of date and not very credible to begin with.
  • Sheila janet 2010/11/02 16:13:59
    Bless your heart Janet. Have a GREAT day! Check out the election results 2nite!!
  • janet Sheila 2010/11/02 16:19:29
    Not a problem.
  • Michaelene Sheila 2010/11/24 17:38:27
    The USPS is a prime example of the big mess our gov't can make. $8.6 billion loss this year. Too big to fail, yeah that's the ticket.
  • Sheila Michaelene 2010/11/24 17:43:14
    LOL, the USPS, AMTRAC, SS, Medicare, all of the governments stuff is screwed. They cant even run a cafe!! They tried and failed. House bank? Don't get me started on that....LOL!!

    Like your avatar. Cheeteh or jag?
  • Michaelene Sheila 2010/11/24 17:54:03
    I find it funny that so many Obamabots are proud of his "tax break for 95% of Americans". These are often the same people screaming about saving SS and the Meds. They do not realize that the breaks were purposely done to underfund both SS and Medicare and are continuing today.

    Thanks for the compliment about the avatar! I think it is a jaguar by the shape of its face.
  • Michaelene janet 2010/11/24 17:42:55
    The hospitals have more mid 6 figure administrators (like Michele Obama once was) whose job is to control loss by rationing care.
    Our country has social safety nets for the poor and disabled, for the rest to each his own.
  • FumbDuck 2010/10/17 02:50:51
    There are two different ways I know of in my city where you can go and not pay. You must submit proof of no or very low income which is more difficult than it sounds. Some people are convinced that this healthcare reform was needed and yet if you don't have money it is hard to prove it. So what will happen in 2014 your guess is as good as mine I am still wondering since what I call the poor people's clinic is still there. If you don't have one in your city or you cannot prove low income then I feel for you but Obama and Pelosi could give a damn.
  • judy ann FumbDuck 2010/10/18 03:44:58
    judy ann
    I just never thought it would be where you have to come up with your portion, before your insurance paid their part.
  • janet judy ann 2010/10/21 12:03:37 (edited)
    Oh but it does happen all the time. When I had breast cancer 5 years ago and was doing radiation therapy I witnessed a woman being told she had to pay on her bill before they would continue her therapy. That is when I started wanting national healthcare like they have in Germany. Germans will tell you it is not perfect but it beats the hell out of the US health system.
  • judy ann janet 2010/10/21 15:17:42
    judy ann
    I hope you are doing better now
  • janet judy ann 2010/10/22 00:09:28
    Oh yes, I have great insurance because I can afford it, but I don't believe my life is some how worth more than the woman who was turned away. I think about her frequently.
    Thanks for the well wishes.
  • judy ann janet 2010/10/22 14:00:42
    judy ann
  • FumbDuck judy ann 2010/10/23 03:02:33
    Oops sorry I thought you were talking about ER stuff and refusals or turning poor folks away if they cannot pay.
  • technotrucker 2010/10/17 02:01:39
    Good for them. That will stop all the free medical care for the illegals in this country. The rest of us may have to suffer a bit for it, but I see it as a good think.

    Seek the truth, or remain a victim.
  • janet technot... 2010/10/21 12:06:46
    Yes that is the christian thing to do, let them die, they aren't really human like your Jesus.
  • technot... janet 2010/10/21 22:49:52 (edited)
    Medical care costs money. Illegals have been getting it for free, paid for by your tax donations. No one is saying let anyone die, what a moronic statement. They are simply asking for money up front. Do you buy a house or a car without someone guaranteeing payment? Illegals think we are the welfare system for them. Why do you think hospitals are closing their doors all over the country? Because bleeding hearts like you think that all things should be free for the asking. Who do you propose pays the bill? Why don't you ask BO and Michelle or Biden to foot the bill for the surgery. That should get you a great response. Eventually even the rich either run out of money, or move somewhere else that doesn't see them as the provide all for the entire Social Welfare system.
    If people would pull their own weight instead of demanding a govt. agency coddle them, this would not be an issue in the first place. Grow up and take responsibility, instead of being a leech on your neighbors labor.

    Seek the truth, or remain a victim.
  • janet technot... 2010/10/22 00:11:52
    First I am not a moron and I don't mind my tax dollars helping illegals when necessary.
  • technot... janet 2010/10/22 17:53:44
    You contradicted yourself and proved my point all in one sentence. Congratulations.
    Since you don't mind, how about you enlist Soros, Barry, Biden, Pelosi, and any other demwits that think that illegals deserve a free ride in this country. You all cough up the 300 Billion Dollars a year that tax payers eat supporting illegal migration into this country. Then perhaps the rest of us can use our money for the really important things, like food, clothing, and housing. If you and your cohorts are taking care of the illegals, then they will gladly give up the jobs they currently occupy keeping legal Americans on unemployment.
    Please feel free to respond with more of your socialist rhetoric, my friends can use the laugh.

    Seek the truth, or remain a victim.
  • Marie/M... technot... 2010/10/22 18:01:34
  • technot... Marie/M... 2010/10/22 18:02:26
    The kool aid is strong with this one Master ! LMAO.

    Seek the truth, or remain a victim.
  • Don Marie/M... 2010/10/24 02:44:18
    Na,Brain Dead more likely...

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