Up-front payments for medical expenses unethical

Last updated: 02/05/14 10:11pm


Hospitals are implementing new polices with the hopes of eliminating lengthy insurance reimbursement times by supplementing their pockets with prepaid deductibles and copay payments.

Turnaround times on health insurance reimbursements are inconsistent and low. In a report from Bloomberg, Barbara Retkowski went to a health clinic in August for a blood treatment. Typically, the health clinic would bill her insurance company after her service. Instead, it demanded payment upfront – more than $1,000 before the doctor would see her.

This rise in upfront payment for non-emergency care has been increasing as deductibles rise, which are likely to accelerate thanks to the Patient Protection and Affordable Care Act.

It is understandable that hospitals and other health providers have employees to pay, facilities to maintain, and other expenditures, but it does not make asking for payment upfront for a service ethical.

“We get our money faster,” Andrew Rubin, vice president for medical center clinical affairs and affiliates at New York University Langone Medical Center, said in an interview with Bloomberg.

I’ve ended up in the emergency room thanks to my immaturity on a number of occasions. Most recently, while being admitted, I was asked to pay my $200 copayment before being taken back into a room.

I was flabbergasted. With a fever over 103, the last thing I thought about before heading to a hospital was making sure I had enough money to pay my copayment before seeing a doctor. They even went as far to ask my girlfriend who drove me if she had the money to pay. We did have the money, but both refused.

If hospitals and health service providers begin asking for payment upfront, it will discourage low-income individuals from seeking the medical care they need. Treating patients first should always be
the top priority, not guaranteeing that they receive money faster.

Hospitals and insurance companies are even bringing in medical debt collectors to ease the financial burden of uncompensated medical services. According to the American Hospital Association, a trade group, in a New York Time’s piece, hospitals in the United States provided $39.3 billion in uncompensated care in 2010.

Accretive Health, one of the nation’s largest collectors of medical debt, agreed in 2012 to pay $2.5 million to the Minnesota state attorney general’s office after allegations arose that the company was allegedly trying to aggressively collect patient debts.

These aggressive tactics, which were disclosed in Accretive’s internal documents by Lori Swanson, the Minnesota attorney general, included embedding debt collectors in hospital emergency rooms to try and pressure patients into paying before receiving care.

Aggressively persuading patients to collect unpaid medical debts is understandable, but it should never come in the way of a patient never receiving the proper care they need. In Minnesota, two patients were approached while in Accretive-affiliated emergency rooms and asked to pay over $300. They both paid, unsure that if they didn’t they wouldn’t receive care.

This makes many people nervous, as debt collectors like Accretive Health have access to patient files. How far will hospitals go to recoup their lost profit? How many people will forgo medical treatment only to need more later on? These are hard questions that need answered as the cost of medical care continues to rise in America.

If health service providers have such difficulty being paid, there is larger issue at stakes that could be solved without pursuing patient payments. The whole idea of paying before services shows that there is still much more work needed to be done on fixing the health care system.

At St. Joseph Mercy Health System in Ann Arbor, schedulers for certain services are being instructed to ask patients for their copay payment at the time of scheduling. While patients don’t have to pay upfront, they aren’t told they don’t have to.

The practice is unethical. People should not have to worry about prepaying for a service while facing a medical incident or other health issue. Paying for big-ticket items is common, like TVs and cars, but those have return policies. You can’t return substandard medical service.

Published Feb 5, 2014

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