Posted on March 27, 2008

Hospitals requesting payments upfront


Some hospitals seeking fees before surgery

By Michael O’Connor
Omaha World-Herald
March 26, 2008

The Nebraska Medical Center has joined an increasing number of hospitals nationally that request that patients pay out-of-pocket costs before a scheduled surgery.

The trend is driven in part by the popularity of high-deductible insurance plans, which can mean bigger out-of-pocket costs for patients, said Rick Wade, spokesman for the American Hospital Association.

Bigger out-of-pocket costs can be more of a burden on patients, so hospitals want to make sure patients are aware as early as possible what their financial obligation will be, he said.

Wade said the national trend of requesting advance payments is partly in response to problems collecting bills.

Jana Danielson, director of patient financial services for the medical center, said the main goal is to help patients know their hospital expenses and eliminate surprises when the bill arrives.

Paying upfront will be an option, and patients who choose not to will still get their surgery, Danielson said. Patients who choose not to pay in advance can get help from medical center financial counselors in setting up a payment plan or obtaining financial assistance.


By Don McCanne, MD

The hospitals are not the villains here. By introducing high-deductible plans, the private insurers have relieved themselves of the responsibility of paying for the initial costs of the medical and surgical procedures and services. In so doing, they have placed the burden of obtaining payment of the upfront charges onto the hospitals and health care professionals. Since large medical bills are more difficult to collect after the services have been provided, it is only natural that the hospitals would request payment in advance.

High-deductible plans are a solution that serves the interests of the insurers. Not only are they relieved from paying bills below the deductible, they are also able to sell these plans at premiums that many employers can still afford.

In contrast, high-deductible plans do not serve the interests of most patients. Innumerable studies have now demonstrated that financial barriers impair access to appropriate health care which, in turn, impairs health outcomes. Placing the hospital in the role of the toll-keeper will undoubtedly cause many patients to walk away from the care they should have (if they can walk).

Wouldn’t it be nice if we had a system in which the Admissions Office of the hospital existed solely for the purpose of assisting the patient who is being admitted? Other countries do that. But not us.

We continue to accept the toll-keeper role because it enables the private insurers to thrive. But isn’t it time for us to adopt policies that are designed instead to make patients thrive?