There is no question that some hospital billing practices directly interfere with patient care. For patients paying out of pocket, the journey to get quality care can be hindered by financial offices. Many hospitals demand 60% or more of a projected amount upfront in order to receive service. This amount is based on the highest possible cost and usually three to five times the negotiated insurance rate.
It doesn’t matter the urgency or disease. It could be emergency surgery or cancer treatment, live or death and the financial people will demand payment before any care is given. I wish I was making this up but I recently went through this with a client.
I received a call from a family member that their mother needed treatment for a newly diagnosed aggressive cancer. The family was told two days before the surgery that the projected bill was $83,000 and $50,000 was needed to proceed. A contract needed to be signed. Because it was a Friday and surgery was on Monday, the financial person said the check had to be there at 8Am Monday morning. There were no payment plans allowed until after the 60% was paid. Also, once the money is handed over and if there is a change, it takes 90 days to get a refund per policy.
What do you do if you are faced with this dilemma? The hospital was holding the patient hostage. You pay, you live, you don’t, you die. My client had traveled out of state to get to this famous specialty cancer hospital. What it meant for her was selling what little she had invested and then to continue, possibly her house.
The interesting part for me was the surgeon wasn’t sure if the surgery could proceed once they took a look. As an advocate and nurse practitioner, I knew two things. First, She was scheduled for surgery before the business office opened. I knew there was a good chance given the medical situation, they surgeons would not be able to perform the complete surgery. Second, I also knew the business office could not stop a surgery. That would be unethical.
If the surgery was unable to proceed, the cost would be much less. I advised holding off on giving any money until it was clear what the actual cost was. Giving $50,000 didn’t make any sense. As it turned out, the surgery could not continue and the initial amount did not apply. But don’t think the business office backed down. They wanted the $50,000 in the hospitals bank. I was told it was to cover future charges.
This is where having an experienced person deal with the business office makes a difference. I requested before any further meetings, an updated itemized bill and found several overcharges. I also was able to track down the supervisors who have the authority to negotiate. This hospital it wasn’t about lowering cost but managing payment time frames. It was also about insuring care while payment was being finalized.
The people in the business office were respectful and professional with me. It was clear the upper administration had a firm and rigid policy. The designed policy by upper management and the board of directors was not user friendly and had little regard for the patient’s outcomes. Basically, the message was; if you want care here, you pay first.
After interceding and working out details, I started wondering how many people left the business offices untreated. I wondered how many people cried and knew they may not get care. I wondered how many people left depressed and scared that they couldn’t find another facility in time who would work out a payment plan. I wondered how many people raged against the politicians and insurance companies who had continued to deny them access to affordable and quality treatment.
My brain was spinning by the injustice of it all. I started thinking about the medical staff and how this policy affected them. It must be difficult to have a patient come in for a consult, design a treatment plan only to find out the patient can’t pay and won’t get care. I assume it happens regularly. Do the physicians design care by financial possibilities?
The question arises, does the nature of payment impact the quality care? I don’t have that answer. When patients with limited resources, present with an unanticipated complication, is the care the same? I am not suggesting the medical staff would not provide adequate care but is there more of stress from the business office on the medical staff to limit care. The doctor had told my client he would treat no matter what. But those words had little impact because the business office tracked people’s visit and were known for putting a hold on treatment.
I would not recommend anyone who doesn’t have good insurance to this specialty facility. It is brutal for anyone who is underinsured or uninsured. There are plenty of options and I will tell clients to seek those and not risk facing the loss of all personal assets.