02/22/05 — Hospital to require up-front payment of insured patients' portion of bill

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Hospital to require up-front payment of insured patients' portion of bill

By Phyllis Moore
Published in News on February 22, 2005 2:32 PM

The signs in doctors' offices that say "Payment is due at time of service" will soon be appearing at Wayne Memorial Hospital.

Starting today, "co-payments" will be collected from insured patients upon arrival for any procedures scheduled in advance. Co-payments are the portion of a claim or medical expense that must be paid by the patient to a provider such as the hospital and doctor for each service received.

Hospital officials said they hope that revamping its registration and billing process will reduce unnecessary paperwork and patient confusion about what is expected of them.

Physicians have been doing this for years, says Rebecca Craig, vice-president of finance at the hospital. Now, hospitals are also finding it to be a good practice.

"I don't think it's a surprise to anybody," she said. "It's an insurance company requirement that they will pay the first $100 or $50. We're just administering it."

Neighboring hospitals have already implemented similar plans. Lenoir Memorial Hospital began charging co-payments more than a year ago. Johnston Memorial Hospital requires it in its emergency department but not for outpatient procedures. Nash General Hospital does the opposite. Sampson Regional Hospital uses a predefined co-payment of $50 or $100, regardless of insurance.

Mrs. Craig said that billing small balances is both expensive and time-consuming for a hospital. Collecting the money in advance is expected to put a dent in Wayne Memorial's "bad debt" category, which averages about $12 million a year, she said.

"To get this out of the way up front is probably the best reason to do it," she said. It is also good for patients to know the extent of their obligation before going to the hospital, she said.

"The benefit for the patient is a clearer, up front understanding of the billing process and their role in it, reducing uncertainty and for some patients, anxiety," she said. "In many cases, the balance of the bill will be settled between the hospital and the insurer, based on pre-determined terms, and the patient will have no further obligation."

Initially, only outpatient services will be affected by the policy. In March, the emergency department will be added with other areas, such as physical therapy and rehabilitation, to follow suit in the coming months.

Unlike patients being asked for co-payments and deductibles before a service, emergency patients will be asked to pay something on their way out. No one, however, will be turned away in the emergency room because of inability to pay, said Mrs. Craig.

In fact, another advantage of the new procedure is helping the hospital identify patients who may need financial help sooner rather than later, she pointed out. Instead of the expense of billing patients who are unable or uncertain about their ability to pay, the patient can be immediately referred to one of the hospital's financial advisors.

Mrs. Craig said meetings were held about two weeks ago with doctors' office managers to explain the new practice. Brochures have also been distributed through surgeons and physicians, anyone who schedules appointments for patients.

The brochure outlines the registration process and includes information about payments required by the patient's insurance company.

The money will either be collected over the phone at the time of pre-registration by credit or debit card, or on the day of the procedure. The amount is usually determined by the insurance company and can be found on the subscriber card. Mrs. Craig said the amount typically ranges from $20-$100.