HCA: It's Hospital Policy To Shakedown Patients Before They Leave
It is hospital chain HCA's policy to "wrest as much cash as humanly possible out of patients before they leave the building," even if the patient hasn't yet recovered from major surgery. The bedside shakedowns occur before the for-profit hospital submits its claims to the insurance company, shifting the burden of payment from insurance companies to patients. Stephanie Mencimer wrote about her experience with HCA after her father underwent knee replacement surgery:
Among the many hospital personnel who stopped in to see my father after surgery was a "financial counselor" from the billing office, who basically started stalking him from the minute he left the intensive care unit.
After making several unsuccessful visits to his room on Tuesday and Wednesday, she slipped her card under the door asking my dad to call her. A little busy recovering from major surgery, my dad didn't get around to it. So on Thursday, the woman called him on the phone in his room, waking him from a much needed painkiller-induced nap to demand a $1,500 down payment on his surgery.
Still connected to IVs, a morphine pump and creepy-looking blood drains, my dad had enough to worry about without getting hassled by the billing office, like dying from a blood clot, or acquiring a drug-resistant infection from the guy in the next room. (Family and hospital staff alike were visiting the guy barehanded despite a big sign on his door warning people not to come within three feet of him without gowns, gloves and masks.) So I went down to the billing office to complain. A supervisor informed me that the counselor was making a "courtesy call" to inform my dad of the limits of his insurance policiy, but she acknowledged that it was hospital policy to wrest as much cash as humanly possible out of patients before they leave the building.
I told the supervisor that hassling post-op patients was incredibly inappropriate, especially given that most of them were too doped up on painkillers to even sign a consent form, much less negotiate billing options. If the hospital had wanted to discuss payment issues, it could have done so when my dad pre-registered with the hospital two weeks earlier. After some perfunctory apologies and some lame excuses, the woman thanked me for the feedback and I left. Later a nurse told us another patient had also complained of a similar shakedown, and she said the nurses were horrified but powerless to do anything about it.
Disgusting, but emblematic of for-profit hospitals. Avoid them if you can.
Hospital Shakes Down Post-Op Patients, In Their Beds [Mojo Blog]
(Photo: Getty)
Post a comment
Comments:
There was an even worse situation outlined in a Wall Street Journal article. An individual receiving chemotherapy had to pay quite a bit of their treatment costs upfront. Of course they were not financially able to cover the costs.
At one instance, the staff would not start an IV dispensing the medication until the billing department received a payment.
Yea this is true. I also agree that the health care system is out of control and something major needs to be done about it.
Also remember that the hospital he went to is a for profit business. It exists to make money. Were they out of line? Yea I think they could have done better. It just shows what they had to go through to collect though.
I understand why the hospital is doing this. As Here_we_go mentioned hospitals don't get paid. They are trying to get as much money as possible. It's pretty crappy to go after patients just after surgery, but what other choice do they have? They can go out of business easily. There were quite a few hospitals in the Jersey area that closed their doors over the last few years, mostly because people didn't pay their bills.
"You think healthcare costs are expensive now, just wait until it's free".
3.5 years ago we had a baby. My wife was on Medicare, the child was on my private insurance. Medicare overlaps with the private insurance too much to make putting both of them on my insurance a good deal.
The hospital did ask us to arrange payment options before we left (we responded by writing them a check). We just did it again, but this time they called a couple weeks ahead of time to set it up. We decided on the same course, but at no chance did they give us a chance to provide the insurance on the unborn child.
After the child was born and coverage became available (retroactive to birth) we provided the insurance to the hospital. When we got the discharge paperwork I went to pay the bill. They decided to just bill us because of the last minute change of insurance.
Exactly. Less hospitals mean even higher bills. I don't know who to blame here. I guess it's just like everything else in life. It takes a little bit of it all to make the system crash.
Patients not paying.
Government not helping.
Insurance screwing over the insured.
It's a combination of everything.
The solution, force everyone to have health insurance either through a variety of gov't programs and continue to allow private insurance. Similar to what Massachusetts is doing right now.
As a Canadian who has had family members fall ill and need operations more times than I can remember -- and who has never once needed to pay a medical bill -- I'm more grateful for socialised medicine than just about any other aspect of Canadian life. The care has always been timely, excellent, and free.
The system isn't perfect, of course -- perfect systems don't exist -- but the value of the peace of mind it offers is incalculable. Also, please remember that most horror stories Americans might hear are pretty much blatant propaganda from your politicians, corporate lobbyists, and the conservative media. It should be sufficient proof that the system works well that every Canadian I know would be aghast at the thought of trading our system for one like yours.
I really do hope, for the health-care future of America, that a President Obama starts things rolling in the direction the rest of the civilised world has realised is the correct one. You might just find your national life expectency starting to creep upward again.
i wonder what the implications are for intentionally/systematically pressuring a person to conduct business transactions when one knows or should know the person is not mentally competent because they're wacked out on painkillers.
Sadly, this isn't restricted to just for-profit hospitals. My wife had surgery at Inova Fairfax Hospital in Fairfax, VA in December. Inova is a not-for-profit hospital system in this area. During her recovery, she got up to use the facilities and by the time she got back, there was an invoice for her "estimated co-payment" (read: not yet submitted to insurance) with a note for her to call the billing department as soon as possible.
I recognize that they need to make ends meet... we all do. But she went through a registration process. They check ID and insurance before even admitting. They know how to get a hold of us. We sign paperwork that says we agree to pay our end of the bargain, by law. There's no need to cause patients additional mental suffering during their recovery process.
It's a sad state of affairs, ladies and gentlemen.
So... the shakedown tony soprano got while recovering in the hospital bed after a chest gunshot wound wasnt pure fiction? They ACTUALLY DO THIS? Jeeze!
You know what... FUCK the hospitals if they are doing this. There is NO WAY to justify any of this. Even if they are getting stiffed by some patients.
They routinely charge/overbill patients for items/procedures patients didnt recieve anyway. Is THAT justified too?
Having once worked for a for-profit hospital company, I would never, never go to one. Beyond the usual billing scams like $15 per aspirin, diagnosis upcoding to maximize insurance payouts, overbilling uninsured patients, and so forth, these companies see absolutely no problem with violating federal health care guidelines (assuming any are left after the reign of George W) and putting patients at risk all to pad the bottom line. I've seen it.
By the way, while the approach from the billing agent was merely crass, the personnel who were visiting the drug resistant patient without protection were endagering the patient and violating all kinds of health care standards.
If he had been pre-registered two weeks prior, then why weren't the payment arrangements made then? This makes no sense. Every time one of us has been admitted to the hospital for something planned, we've done the pre-registration and there are tons of documents to sign. Chief among them the one about "financial responsibility" and insurance coverage, out of pocket expenses, unforseen charges, etc...it's ALWAYS abundantly discussed. The OP doesn't say, but I imagine this was done with her father and they got a little over-zealous post surgery trying to collect.
If a hospital refuses to treat a patient because they are waiting on a payment, and as a result that patient dies, have they just committed murder?
I mean, they knowingly and wilfuly let the person die. Can they actually get away with effectively killing you just because you don't pay?
Perhaps, "Its hospitals" would have been better than, "it's hospitals."
@mycroft2000: The problem isn't that people in the US don't want free healthcare, it's that they don't want to pay for it. Canada and the UK have great healthcare systems...but you pay through the nose for it. Taxes in both of these countries are very high relative to what US citizens are accustomed paying. You can't just jack up the tax rate to what would be necessary to pay for free healthcare and think that everything will just go over soooo well. People just don't realize that healthcare costs money and it's coming out of their pockets whether they want to pay through private insurance, increased taxes, or even more increased taxes when hospitals start going out of "business" left and right and the government decides to bail them out.
But our priorities aren't on healthcare. Perhaps that'll change with the next election.
I got to witness this at a not-for-profit hospital. I had a friend who had type 1 diabetes and she landed in the hospital a number of times. Of course she didn't have insurance because she had a hard time keeping a steady job due to landing in the hospital from time to time or being sick.
One of the times I picked her up to go home someone from the billing department showed up before she had been discharged. This person demanded payment and when she refused because she had no money the billing person said they would not release her until a payment and arrangements on the bill were made. So they were basically holding her hostage for money she admitted she didn't have. She finally told the billing person to stuff it, picked up her things and left without being offically discharged.
She said it happened every time she had ended up in the hospital. Before anyone starts blaming her, she was uncontious when dragged into said hospital so she had no say in racking up the bill.
Insurance only pays a presentage of the billed amount. I've seen bills for $300 which insurance only pays $30. The actual test probably costs less then that but if the hospital billed $30 they would only get a buck or two. That could be a reason uninsured costs are so high
@facted: Look at most people's private health insurance, even through work as a tax. Were paying more in "taxes" than people in the UK and Canada if you lump insurance premiums here into a person's tax debt. We pay more in insurance premiums through work in a month than we do for all other "tax" deductions combined.
@dragonfire81: Hospitals are generally obligated to help people in an emergency situation, regardless of ability to pay.
I don't socialized healthcare can work in america. Look at the crap returning vets are going through. Remember the scandal at walter read how patients were in the same room as vermin and other stuff. That place was supposed to be the poster child of government run healthcare. Then you will have all the fraud to deal with. It'll get worse. Another possible problem is what about illegal emigrants? Costs will still stay high because they still need treatment. I BET with government healthcare we will be paying more for less service.
* Should have said I don't think
How does one find out whether a hospital is for-profit or not?
@Mr_Human:
Just look at their website. All non-for-profit hospitals advertise themselves as such.
This is the hospital I work it. It's written all over the website.
@facted: Canada is also a much smaller country than ours: 33mil to our 280mil. It would be _a lot_ harder to implement a fully socialized system in this country that's anywhere near efficient. I think Obama pointed this out somewhere.
@facted: Actually, our tax burden isn't all that much higher than Americans'. The main difference is that we have a huge chunk of our tax dollars going to health care, whereas the US has a comparable percentage going to its military. Before the Iraq disaster, the US could have easily ("easily" in the logistical sense, not the cultural one) cut military spending in half and put the savings toward health care, but, sadly, that's impossible now.
It really boggles the mind (and is rather depressing) to think of all the good that the hundreds of billions wasted on Iraq could have done.
At least this is better than that screwed up Universal Healthcare dealy the rest of the world subscribes to.
If you can wait for the surgury, then go to a resort hospital overseas. These places have much better medical care and the doctors are top notch. You will save money too even with the cost of airfare.
@Mr_Human: Each province actually runs its own healthcare system (Ontario has something like 12 million people), so if each US state were to do so, the implementation of a public system would be somewhat more manageable. Of course, then you'd run into the problem of a rich state like Washington having far better care than a poor one like Mississippi ... You're right, though, it does make a person's head hurt to think about how difficult a change like this would be.
Dont they also advise you against making any important financial and life decisions (sp) in the days following anestesia, I know they always went over this with me prior to and after surgury.
@hamsangwich: Instead of the fed mandating everyone to have insurance, why don't we skip the middleman and just get going on universal healthcare?
I think we need to take a long hard look at the changes we need to make with regards to the medical industry.
@hamsangwich: I technically get paid by the state of Massachusetts(personal care attendant paid by medicaid) the governer just denied us medical benefits, we are required to have insurance, I make "too much" for the assistance plans, I'll have to give up my car to get this medical insurance, I need my car for work. It is SO not working in Massachusetts.
Here are a couple of ideas that actually have some backing regarding universal healthcare:
I do work with both groups. Its certainly disheartening as a medical student to see how crappy the system is, but its so broken at this point its really only a matter of time before change has to happen, simply because a complete collapse is inevitable.
Sadly, healthcare in America is about money first, the patient second--a distant second. How else to explain that we are number 1 in spending for health care and in the middle of the pack (among industrialized countries) in quality of care. Pathetic
Hospitals always get paid. By meeting some very easily attained goals, all unpaid accounts are reimbursed by the state (at least in MN). Denying health care is immoral under any circumstance.
When discussing national healthcare, if you can get beyond the knee-jerk reactions, think about the longer term savings. Sometimes it's the poorest who need the most expensive treatments and are unable to pay. With a stable system, everyone will spend more time getting preventive checkups and early care and less time going in for expensive emergency treatments. Compare the cost of regular dental cleanings, checkups, and even braces to rescue plans involving fillings, root canals, crowns, veneers, etc. The savings are there.
"The United States has the best healthcare system in the world."
--Dick Cheney
Turning to pg. 739 of the Political B.S. Decoder, this kind of rhetoric (when referred to after reading stories like the above) is explained as "Americans are as dumb as a box of rocks."
Just goes to show that the rest of the modern world ([www.pbs.org]) has nothing on our leadership in this area.
A hospital screwed up quick lets put the DMV people in charge of a mandated federal health care system!
@mycroft2000: One other thing - the provinces agree to honor each other's residents and settle off regularly. So, if I'm in Vancouver and need my appendix removed, I still pay nothing and my province gets the bill (provided I've got my health card with me when I'm travelling.)
Yes, there are treatments and services the provinces don't cover (vision, dental, outside-the-hospital-drugs, physio) but my employer supplies a plan for those that's pretty generous. These plans very from company to company. For example, my plan covers 80% of doctor ordered physio claims to a yearly maximum.
My provincial health card and my employer paid benefit card, I never leave home without them.
@arcticJKL: Hospitals provide you care. Health insurance provides you financial coverage.
All of the US plans involve government controlled INSURANCE.
Don't let you misguided hysteria get in the way of reality.
Iam neither for or against national healthcare in America where I live. This is because of the outcome I see.
No matter what we go with it will basically not work. The reason for this is because of such corruption in the political and business enviroment in place in America. If we dont clean up the corruption in America we are going to suffer alot more in the future.
@hypochondriac: The billing system is really just a massive shell game. I think it is actually *illegal* for a care provider to charge less to a cash-paying (uninsured) patient than they would bill Medicaid...despite the fact they won't have to pay office specialists to code everything and deal with reimbursement.
Funny how the health-care industry was going along just fine until the government decided to get involved...
Everytime I go the doctor, dentist, eye doctor, or any other health care professional I always get payment/cost arrangements ironed out BEFORE anything is done.
How can you not get that straight beforehand? How can you be upset when you didn't take care of your business?
Somewhere in here I would have thought to myself, Man , I hope the insurance pays for all this." Was that not a concern?
Then put it on the hospital employee who is just doing his/her job like it's their fault that you didn't do you due diligence. It's like the speeder who gets mad at the cop for writing him/her a ticket.
When you go to get your car repaired do you not make sure the costs/expenses are known and taken care of before any work is done?
When you get some work done on your house do you make sure you know how much it is going to cost before the work is done?
Sick people and their family expect special treatment because they don't feel well. Just because your sick doesn't make you special or immune to the rules.
Well don't you all realize that HCA has to make back that billion plus dollars in fines they had for defrauding the government? http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm
@mycroft2000: That is quite possibly the most succinct, calm explanation of my feelings I have ever seen. Bravo. (Brava?)
While travelling in the states the last two weeks, the thing that was perhaps most shocking to me were the advertisements for hospitals on the radio, the way one might advertise hamburgers, though instead of proclaiming best fries, a given facility advertised best cardiology departments.
My mother has dual citizenship, and is flat refusing to move back to the US after her divorce, as the health care alone would kill her. Another friend of the family, over 90 years old, was billed $40,000 for a hip replacement when he fell at US customs and they took him to Buffalo instead of St. Catharines. The US system is fantastically broken, and it seriously makes me question where I'll attend graduate school - This is one thing I really do not want to have to worry about.
Every hospital has a patient/nursing ombudsman. Usually a senior nursing supervisor that is dedicated to handling difficult patient complaints.... and I don't mean complaints from "difficult patients".
The patient/nursing ombudsman may even has the power to fire. Regardless of his/her power, he/she always has the ear of the hospital administrator, the director of nursing services and the chief medical officier.
In situations such as this one, he/she is GOD.
There would be no "courtesy" call, as the patient/nursing ombudsman would understand the effects of the drugs and the liability to the hospital.
The first thing I do when a family member is in the hospital is find the patient/nursing ombudsman's office and telephone extension. It does wonder's just saying "wait, let me call Nurse Smith's office and discuss the treatment program with her".
You would be amazed at how many people leave the hospital, never pay thier bill, and never call the hospital back.
I'm not arguing for the hospital. The entire health care system is so out of control.