Uninsured patients negotiate final hospital bill

Uninsured patients negotiate anywhere from 20 to 40 percent off area hospitals’ medical-care charges, depending on what other federal, state or local assistance they receive.

These charges and collections are significant, hospital representatives say, because care for the uninsured ranges from about 7 to 15 percent of their total business.

Everyone who is admitted for a medical procedure, area hospital officials say, will be charged the same price at their hospital whether they have health insurance or not.

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How much of that bill the hospital collects from the patient or insurance company, however, depends on the rates it negotiates with insurance carriers, Medicare and Medicaid. Uninsured patients face individual negotiations with hospital staff.

At the four major hospitals in the Boulder Valley – Avista Adventist, Boulder Community, Exempla Good Samaritan and Longmont United – the uninsured can negotiate what they will pay.

The 20 to 40 percent discounts tend to be approximately what the hospitals charge insurance companies when billing a procedure. For insured patients, the insurance companies cover another 40 to 60 percent of the costs, depending on the coverage they have.

While the four hospitals report how much of this charity care they donate each year through their discounts, they do not break out how much of the total is losses due to bad debt for uninsured and insured patients.

About 45.8 million, or 15.7 percent, of Americans are uninsured according to the latest U.S. Census Bureau data from 2004. The percent is a little higher in Colorado, at 17.1 percent and slightly under the national average in Boulder County at 13.5 percent – although, the latest figure is from county is from the 2000 Census.
All four hospitals stress that they provide the same level of medical service regardless of a patient’s ability to pay.

In emergency situations, medical care is the priority, and the bill is settled afterward.

“In an emergency situation medical care always comes first. Then at some point before you leave the hospital we’ll have a discussion with you about your bill, and these folks would have access to our financial counselors as well,´ said Rich Sheehan, spokesman for Boulder Community Hospital.

At Exempla Good Samaritan Hospital in Lafayette, about 15 percent of the hospital’s business comes from uninsured patients, said Rick Rhine, director of revenue services.

“Every uninsured patient receives a 40 percent discount at the time the bill draws,” Rhine said. After treatment, patients meet with a hospital financial counselor to work out some kind of payment plan over a period of time, he said.

The time is negotiated depending on the patient’s ability to pay, and there is no interest charged. This typically is not a long-term payback, like a 30-year mortgage on your home, Rhine said. “It’s a reasonable negotiated amount of time.”

Many uninsured patients are able to pay their bills on time, Rhine said. It’s a misconception that all uninsured patients are low-income people.

“There are a lot of wealthy people in this area who take the risk, and they’ll pay the cost,” Rhine said.
According the U.S. Census Bureau, about 35 percent of uninsured patients have household incomes of $50,000 or more.

For those patients who can’t afford the payment plan, the hospital has another set of procedures, Rhine said.

“We first attempt to see if they qualify for Medicaid benefits,” he said. “If they don’t qualify for Medicaid, they might qualify for our charity care program. It’s designed for uninsured patients whose income falls below 400 percent of the federal poverty level.” For a single person, that’s about $39,200. Other assets, income and expenses also are taken into account when figuring the amount of charity care for a patient, he said.

At Boulder Community Hospital in Boulder, 7.6 percent of patients at were “self-pay” in 2005, Sheehan said. They were either uninsured individuals or people with insurance who choose not to use it “for personal reasons,” including not wanting it reported to their insurance company, he said.

Prior to an elective procedure, uninsured patients are encouraged to talk with an in-house financial counselor, Sheehan said. “They would sit down and review your financial situation, and if they felt you could qualify for financial aid like Medicaid or the Colorado Indigent Care Program they would help you fill out the forms for that.”

The indigent care program is available to underinsured and uninsured Colorado residents who are U.S. citizens, or migrant farm workers who are either U.S. citizens or legal immigrants.

Boulder Community has a prompt-pay discount on elective procedures that gives patients a 30 percent discount if they pay within 30 days of treatment.

The hospital also is trying “an experiment” in its imaging department, Sheehan said. Patients needing an elective MRI or X-ray can get a 40 percent discount if they pay on or before having the procedure.

“We’re trying to align what an uninsured person would pay with what an insurance company would pay us,” Sheehan said.

These programs only apply to elective care, Sheehan emphasized, not emergency treatments.

At Avista Adventist Hospital in Louisville, uninsured patients can find out about the hospital’s help for the uninsured online, said spokeswoman Dana Berry.

Because Avista is a member of Englewood-based Centura Health, patients can find the hospital’s policy from Centura’s main page at www.centura.org and by clicking on the “Road to Transparency” link, then clicking on “Charity Policy.”

A financial aid application is available online. The patient fills out the form, provides the necessary proof of income and talks with a financial counselor at the hospital, Berry said.

Patients are eligible for financial aid after they have exhausted other payment sources including Medicaid, Colorado Indigent Care, Hospital Foundation Funds, Colorado Child Health Plan Plus and Doctor’s Care Program, according to the policy.

Avista provided $9.7 million in uncompensated charity care in 2005, she said. Avista provides emergency care regardless of ability to pay, the policy says. Avista also offers a 40 percent prompt-pay discount for patients who can pay the whole amount up front, Berry said.
At Longmont United Hospital, uninsured patients get a 20 percent discount on their medical bills. While that’s less of a discount than the other area hospitals, patients also should take into consideration the price of the procedures, said Longmont United spokesman Matt Hartzler.

Similar to other hospitals, Longmont has financial counselors available to discuss the negotiated prices with patients.