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Health & Medicine

Profit Over Patient: Doctors Asking For Cash Before Care

— December 7, 2016

In what is becoming an all-too familiar scenario for countless people who either need to see their primary care physician or receive treatment in a hospital, whether for a scheduled procedure or an emergency condition, countless doctors and hospitals are now requiring payment for service before providing necessary care to patients.

For the few who can afford to pay considerably high health insurance premiums that result in lower deductibles, this probably isn’t as frightening an issue as it is for the hundreds of millions of Americans who are not in the same position. Average citizens must often choose health insurance plans with the lowest monthly premiums in order to afford their most basic costs of living. Doing so, however, means higher deductibles when it comes to receiving medical treatment, which is typically more than a person can afford out-of-pocket at one time. These deductibles can sometimes be as high as $5,000. Who has that kind of cash at the ready should an emergency occur? I know I certainly don’t.

In what is becoming an increasingly more popular practice, doctors’ offices, clinics and hospitals have begun estimating what a patient will owe for their particular form of treatment and then attempt to collect it at that time. Among a number of other problems associated with this method is that in some cases, certain treatments are overestimated and end up not being necessary or provided, yet the patient has still paid for the service/s.

Other methods of collecting payment include an increased push for patients to allow their credit card information to be stored within the provider’s system and charged at will; if a person has a $10 co-pay, this likely wouldn’t pose a problem, but what if the deductible is $1,500? Aside from taking months to pay off or possibly exceeding their credit limit, it also has the potential to damage their credit score, leaving them in an even worse financial position than they were before receiving medical care.

In the case of 34-year-old Tai Boxley, a single mother from Tulsa, Oklahoma, she has been diagnosed as having uterine prolapse requiring the need for a hysterectomy. While she and her son are covered by insurance she receives through her employer, they each have a $5,000 deductible. Boxley’s doctor’s office has estimated her share of the cost for the surgery to be $2,500 out-of-pocket and the doctor has stated he will not perform the procedure until the amount has been pre-paid in full. Boxley said, “I’m so angry. If I need medical care I should be able to get it without having to afford it up front.”

Doctor being paid cash upfront before providing treatment; image courtesy of
Doctor being paid cash upfront before providing treatment; image courtesy of

Some offices and hospitals are willing to discuss payment plans with patients, though even then, the monthly costs of care are so high that many consumers fall behind in their scheduled payments, putting further strain on their credit scores (and assumedly, their mental well-being).

According to Richard Gundling, who serves as a senior vice president at the Healthcare Financial Management Association, around three-quarters of hospitals and doctors’ offices in the country ask for time-of-service payments, also known as point-of-service collections. Not only does this practice leave patients feeling angry, and sometimes desperate because they are unable to afford the care they need, Gundling said it’s not the wisest method for healthcare providers because “there’s more risk with these higher deductibles, because the chance of being able to collect it later diminishes.”

Numerous providers are teaming up with companies designed to collect point-of-service fees, which is resulting in patients putting off necessary treatment or procedures out of fear of winding up in perpetual debt. This frequently results in more emergency room visits, where care was once guaranteed regardless of a person’s financial ability to pay. However, even that is beginning to change.

Any patient who has a medical emergency must first be treated and stabilized before financial personnel may discuss payment with them according to the federal Emergency Medical Treatment and Labor Act (EMTALA), but according to ER doctor Vidor Friedman, who serves as the secretary-treasurer of the American College of Emergency Physicians’ board of directors, if a person seeks treatment in the emergency room and their condition is labeled a non-emergency, payment may be discussed before treatment.

In Boxley’s case, she is hoping to discuss payment plan options with her doctor’s office in order to have the procedure in January. Though she already pays $110 per month to maintain her insurance, she said she would make payments to the office every month. She stated she hopes they will work with her tight budget and accept a smaller monthly payment, otherwise she will have to rely on her graduate school student loans in order to pay it off sooner.


Doctors And Hospitals Say ‘Show Me The Money’ Before Treating Patients

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