Providers try to collect patient fees upfront

Kaiser Health News ran an article about medical centers, hospitals, and doctors' offices increasingly asking patients to pay their portion of the appointment or procedure fees upfront. Some medical facilities have been doing this for several years, but as deductibles continue to rise, it appears that this practice is becoming more commonplace. While this practice may seem jarring to the patient (to have to worry about the financial consequences before the appointment or procedure), medical groups hope to reduce the time they spend collecting on bills and the amount of bad debt they experience.

The article profiled an administrative assistant who needed a hysterectomy and was asked to pay upfront. She had insurance, but the deductible was $5,000, and the doctor estimated that the patient portion would be around $2,500. The administrative assistant said that she was angry at being asked to pay for her portion of medical care before she could receive service. Previously, it was much more common for the procedure to be done, then the insurance billed, and then finally the patient billed for the patient portion. However, a number of patients would then be unable or unwilling to pay, forcing medical groups to write off uncollected amounts as bad debt. All of this raises the question: what should happen when someone is unable to pay for necessary medical care? Under the older model, medical groups would simply expect to not see some of their billings (which they claim forces them to raise prices on everyone to cover what is known as "charity care"). Notably, some non-profit hospitals have received bad press for their aggressive collection tactics. Should the insurance company pay? The premium was priced assuming a certain deductible; forcing insurers to pay would certain raise premiums for the general population. Should the government pay? Should the patient be forced to wait? These are questions that significantly affect health policy, and ones that do not lend themselves to easy answers. While America figures out a response to these questions, the medical community has understandably taken steps to protect its bottom line. Should this practice become more commonplace, it might have the effect of forcing patients to be more discriminating in the care they receive and their selection of a medical practice to visit. Ultimately, forcing patients to shop around might actually create more pricing pressure on the providers.