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Insured Patients Finding They Must Pay More For Upfront Care

Patients who need medical procedures are accustomed to following a familiar pattern: Talk to a doctor, schedule it at a hospital, have the procedure done and then get a bill in the mail a month later for your share of the cost.

But in South Florida and nationwide, some insured patients are being asked by hospitals to pay larger portions of their bills upfront — and sometimes hospitals will not do the procedures until they get their co-payments.

Hospitals administer emergency treatment without asking for payment first, but elective or scheduled procedures — anything from nose jobs to chemotherapy — can be withheld depending on a patient’s ability to pay.

An informal survey of 22 hospitals in Broward and Palm Beach counties found that all have required upfront payments for elective surgeries for several years. The change that might shock patients, hospital officials said, is the larger amounts requested as insurance companies require patients to make higher out-of-pocket payments.

“As the economy worsens, employers are having a harder time affording insurance for their employees, they’re increasing the patient portion, and patients’ benefits actually decrease,” said David Smith, chief financial officer for tax-assisted Memorial Regional Hospital in Hollywood.

The change has caught some South Floridians by surprise. Fort Lauderdale mortgage broker Jack Atwell, 58, was directed by his doctor at Broward General Medical Center to have a cardiac catheterization test after stress tests indicated he was at risk for a heart attack.

The hospital staff told Atwell two days before the procedure in June that he needed to bring with him his full share of $2,500. After Atwell told the hospital he could not come up with the money in two days, Broward General lowered its request to $1,000. He offered $500. After the hospital rejected that offer, the procedure was canceled.”At this point, between the stress of the potential heart attack and trying to deal with this and the procedure itself, I was in tears,” Atwell said. “Here I am, a person who’s worked his entire life, paid his bills, does the right thing, has insurance, and I can’t get a procedure that I need done.”

After calling other South Florida hospitals, Atwell learned Holy Cross would not charge him upfront, and he had his procedure done in early July. He has since switched to a doctor at Holy Cross.

Atwell said he thought having insurance would be all he needed to access care.

“I really didn’t have any expectations,” he said. “I had never confronted a problem like that before.”

Broward Health, the tax-supported hospital district that operates Broward General, could not comment on the specifics of Atwell’s case because he declined to sign a consent form authorizing the district to discuss his medical and financial situation. District spokeswoman Sara Howley did say that Broward General did not bar Atwell from receiving care.

“We feel that this is more of an issue with an insurance company,” Howley said.

In fact, even the insured are finding their out-of-pocket payments are growing faster than their wages as employers try to pass on high health-care costs to their employees through greater cost-sharing. Health-insurance premiums increased 78 percent between 2001 and 2007, according to the Kaiser Family Foundation, a health-care research organization.

“Employers are either cutting back on the benefits that they offer employees or asking employees to contribute a bigger stake in their health care,” said Mitch Lubitz, a spokesman for Humana, a health insurer with more than 154,000 members in South Florida.

The Florida Hospital Association is seeing a “spotty trend toward upfront payments” in Florida, said Rich Rasmussen, the organization’s spokesman.

The Internal Revenue Service looked into the issue for the first time in 2006 through a voluntary survey and found 14 percent of 481 nonprofit hospitals nationwide required patients pay or work out a payment plan before being admitted.

Patient advocates said asking for payment before care is delivered, and with short-term notice, places stress on vulnerable individuals who might face life-threatening illnesses. “Somebody facing a catastrophic illness and having to be burdened with the extra stress of paying a co-pay or premium is just unconscionable,” said Laura Goodhue, executive director of Florida CHAIN, a consumer-health advocacy organization based in Palm Beach Gardens.

Hospitals argue that rising health care costs and hard economic times have caused an explosion in care for which they are not paid.

According to the Florida Hospital Association, state hospitals spent $2.4 billion on uncompensated care in 2006, a growth of 73 percent since 2000. The association attributes the growth partly to growing numbers of uninsured Floridians. Experts estimate 3.7 million people — 21 percent of the state’s population — are uninsured, the third-highest proportion in the nation in 2006.

Other issues, unique to Florida, are also factors.

“We have a number of visitors who use our services who tend to be out-of-town residents or out-of-country residents and then leave,” Rasmussen said.

(c) YellowBrix 2008

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