Hospital Debt Collectors Moving From Back Office to Bedside
The New York Times writes, “Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside.”
Employees were told to stall patients entering the emergency room until they had agreed to pay a previous balance, according to the documents. Employees in the emergency room, for example, were told to ask incoming patients first for a credit card payment. If that failed, employees were told to say, “If you have your checkbook in your car I will be happy to wait for you,” internal documents show.
Employees at Accretive’s client hospitals ask patients to make “point of service” payments before they receive treatment. Until she went to Fairview for her son Maxx’s ear tube surgery in November, Marcia Newton, a stay-at-home mother in Corcoran, Minn., said she had never been asked to pay for care before receiving it. “They were really aggressive about getting that money upfront,” she said in an interview.
Ms. Newton was shocked to learn that the employees were debt collectors. “You really feel hoodwinked,” she said.
While hospital collections at Fairview increased, patient care suffered, the employees said. “Patients are harassed mercilessly,” a hospital employee told Ms. Swanson.
Tags: Health Care
Sounds like a disgruntled employee. In a lot of cases that upfront money is they only money a health care provider will ever collect.
I have no problem with this. Obviously, the collectors were not harassing patients on ventilators rather folks who use the ED as primary care. Even in a single payer system, ED as primary careis a bad idea.
i wonder if they use the ER as primary care because they have been priced out of our wonderful free-market health care cartels…
@walt, the reason why people use emergency rooms a primary care is because they don’t have access to primary care.
At least locally, we are lousy with walk in clinics. There is one in the KMart for crying out loud. The reason people use the ED is they don’t want to PAY for primary care.
NOW are we ready for single-payer health care?
No, not yet? I guess it needs to get even worse then.
“The reason people use the ED is they don’t want to PAY for primary care.”
The reason people go hungry is they don’t want to PAY for food.
The reason people are homeless is they don’t want to PAY for a house.
The reason people take the bus is they don’t want to PAY for a car.
Sheesh.
And? No one said it was right or wrong, but as it is now,if you use Acme’s services to feed yourself, or fail to pay your mortgage, you can expect someone to come looking for you so they get paid. There is no reason why a hospital shouldn’t try to collect as well.
Nemski: There isn’t a doctor out there who will not take cash. And if you shop them, you will find ones who come way down off their billing rates for procedures or visits. The problem is: people don’t shop them. They don’t shop them because they see health care as an unforeseen expense. They think the pain will “go away”. When it finally gets worse they are unprepared and have no other recourse but the ER. You can pay a little bit for wellness, or you can be part of the health care industry problem if you are uninsured.
Walt: Yes, that’s certainly the answer to America’s health care situation — have everyone bargain with the doctor like an Iranian rug merchant. Simple solutions for simple people, apparently.
maybe even barter with a chicken
“There is no reason why a hospital shouldn’t try to collect as well.”
Actually, there’s a very good reason — stress is terrible for your health.
That’s also a very good reason that health care should not be run for profit.
Chickens are what makes the world go ’round. And that rug merchant might know something you don’t.
@m “There is no reason why a hospital shouldn’t try to collect as well.”
Part of our social contract is that people who need help, get help. That is what a 1st world country does. That’s what ALL of the 1st world countries do.
Only in 2nd and 3rd world countries are people allowed to suffer on the street without needed care.
So which do you want us to be? 2nd world or 3rd world?
Health care shouldn’t be run for profit, all of Delaware’s hospitals are non-profit entities. Profits are amassed by the insurance companies. Unless I read the op wrong, we’re discussing whether or not a hospital should try to collect outstanding bills prior to providing additional services. I see nothing wrong with this. My doctors and dentists do it, my not for profit electricity company does it, and I naturally assume that the not for profit hospital I choose to do business with does it. The hospital still has bills to pay, services to offer, and employees who deserve fair compensation for services rendered. Nobody is doing this work for their health;).
I don’t think anyone is talking about refusal to deliver care. Once again, we are discussing whether or not we are outraged that a hospital tries to collect debts owed prior to new services provided and also the definition of aggressive collections techniques. I’m not outraged by either, how about you?
“all of Delaware’s hospitals are non-profit entities.”
Yet they still have to look at the bottom line, which is why all the costs of the indigent are incorporated into the bills paid by those insurance companies.
“we’re discussing whether or not a hospital should try to collect outstanding bills prior to providing additional services. I see nothing wrong with this.”
Your poor vision is not my concern. There’s plenty wrong with it, you just can’t see it.
Because the system is run for profit, even though elements of it are not, the entire system spends (wastes) incredible amounts of time, money and effort in finding ways to shift costs to another entity.
“The reason people use the ED is they don’t want to PAY for primary care.”
Wrong again. Most of the people using the ER for primary care live in areas that lack primary care physicians. Most have no access to the Wal-Mart, or anywhere else with a walk-in clinic.
You might try reading up on subjects rather than relying on your own, necessarily limited, personal experience.
“we are discussing whether or not we are outraged that a hospital tries to collect debts owed prior to new services provided and also the definition of aggressive collections techniques. I’m not outraged by either, how about you?”
No, I’m not outraged, but I do believe this is deleterious to the health of those being dunned, and I believe it’s being done not to collect money nearly so much as to spread the word in the community that these hospitals are run by assholes, with the goal being to push non-paying customers to other hospitals with a lower asshole-to-debt ratio.
Again, your inability to feel empathy for the poor and sick hardly means we should close the book on the subject.
“Part of our social contract is that people who need help, get help.”
It’s also part of our law: Hospitals cannot turn away emergency patients based on an inability to pay.
@m “I don’t think anyone is talking about refusal to deliver care.”
Demanding money up front is the same thing. For many poor people it’s just the same thing.
we’re in a bad place when people look upon care received at hospitals like any other good or service. Car dealerships for example are morally justified in making people pay off one car before putting a down payment on another…. they usually dont because everything is based on credit there. BUt medical care is not something you decide to get on a goof. You cant save up for your appendectomy or put a heart valve on layaway. sometimes people who dont have a lot of money need medical attention faster than they can pay for it.
From the article:
“Employees at Accretive’s client hospitals ask patients to make “point of service” payments before they receive treatment. Until she went to Fairview for her son Maxx’s ear tube surgery in November, Marcia Newton, a stay-at-home mother in Corcoran, Minn., said she had never been asked to pay for care before receiving it. “They were really aggressive about getting that money upfront,” she said in an interview.”
I don’t think anyone was refused service.
I like to think my personal experience is pretty spot on as I’ve been providing these service to the sick and indigent as well as the well heeled and insured,for better than 25 years in big cities and small.
@SB see above. No one was refused care.
not yet… but this is the type of behavior that used to be considered unthinkable. We are trending toward a culture where only those who can afford it get care. everyone else better have a great immune system and flawless genetics.
Just so we’re all clear here, I’m not advocating denying anyone service. I’m merely suggesting that, in the current system, attempting to collect fees for service is not all that outrageous as the OP would like us to believe.
Dude, it has been going on for over twenty years.
“@SB see above. No one was refused care”
The quote you cite does not indicate whether services were given or not.
As for ER care:
Asking to pay an outstanding bill is one thing. Asking it in the emergency room is something ENTIRELY different. Read: Possibly illegal due to a law passed in the 80’s and signed by Reagan, making it illegal to deny emergency room care.
I think the hospital staff was using debt collection tricks of the trade to leverage people into paying. They probably didn’t deny service, but I would be willing to wager they inferred, implied and possibly lied to get a payment. This is how its done in other debt collection sectors.
Collecting fees is not outrageous….. collecting fees from someone in ICU is heartless. Even letting people thing that they have to pay before getting treatment is heartless…. but hell, at least the free market gets to work.
As I understand the situation, no one was asked to pay for care prior to receiving it (I’ll give you the shot but I want the money up front). My understanding is that they were asked for payment on a previous service for which they had not paid.
Second, we in this nation have yet to decide that health care is a fundamental right of citizenship (or illegal immigrantship whatever). Or is the fundamental right really acesss to health care? We have the right to life, liberty and the pursuit of happiness sure, but are those rights broadly defined to include such things as health care? How about a chicken in every pot? Is there a fundamental right to that? Car? House? College education?
If someone chooses to live in a remote area and has no medical facility does society incur an obligation to build and staff one to provide that medical care? Where do we draw the line? How much is too little. How much is enough? It’s easy to just to say that we should all have free medical care. But where does it come from? What are the limits? Do I have a right to a new kidney if I need one?
Once you figure out the rights and limits, then you have to decide how it will provided within the resource constraints of the nation and it’s communities. There is no free lunch. I think it’s great that everyone get all the health care they need and want, but I’m pragmatic and I recognize that there has to be limits because we do not have unlimited resources. But most of the conservations seem to never tackle the limits. We simply cannot afford to have unlimited health care for an unlimited number of people for an unlimited length of time regardless of how eglitarian it is.
I think you guys are reading way too much into this. No one from the hospital is now or ever going to ask you to even up while their hand is on the power cord of your ventilator in ICU.
Additionally, all this speculation about “getting the word out on the street,” or “inferring, lying, and implying” is simply that- speculation. The bottom line is hospitals need to get paid in order to provide the care they are chartered to perform. It is not heartless or illegal (or in most cases even for profit), it is how they are able to continue to deliver the services needed in the current system, even to the indigent.
Every time I read these threads with all the right-wing posturing, I throw up a little in my mouth.
Actually, I’m a single payer supporter myself, but overtly that is not what this thread is about. That’s why I kept writting “in the current system” above. Single payer would of course render this thread moot (except for EDs as PCPs).
meatball–I totally get what your saying. I’ve worked all varieties of healthcare facilities, and I have seen patients be asked for money up front at the ER window after being triaged if there was no insurance. I have seen folks peel off 3K to continue w/ the services at the hospital, or opt to be transferred/directed to the county hospital where indigent care could be more efficiently managed. Ability to pay isn’t even in the equation if it’s a true emergency, and services are not denied.
In the case above–having your child get tubes in their ears, is a planned, elective surgery that doesn’t pass a sniff test of emergent care. Like wisdom teeth. Chances are there is a deductible and/or co-pay, and seeing the account is already in arrears it is not out of line for the facility to front end expect that to be taken care of, before extending further services. Any outrage taken with this can be quietly directed to the hospital’s billing office and the medical social worker. It happens all the time. So does getting stiffed for unpaid accounts. Why fault an industry that’s trying to stay viable to be around to treat the next real emergency? And yes, I had a facility tell me at the beginning of my new benefit year–they were not ordering my daughter’s next round of chemo until my very high yearly deductible was paid–since they would be first on that billing cycle, and they knew insurance wasn’t picking it up yet. OUCH! Oh did we have a talk…..
My experience has also shown me that most facilities (at least the ones I worked for) are willing to work out payment plans for even partial reimbursements. As you said, Joanne, everybody wants the resouces to be there when they need them.