More Hospitals Ask For Up-Front Payments, Increase Collection Efforts

The Tennessean on Thursday examined how "as the volume of unpaid medical bills increases, hospitals in middle Tennessee and nationally are turning into more aggressive bill collectors." Hospitals "increasingly ... are using sophisticated computer models to screen the insured as well as the uninsured, estimate their ability to pay and ask more patients to pay some of what they owe up front or soon after treatment," according to the Tennessean. While hospitals "aren't denying patients critical care," they "may decline to perform elective procedures on patients who can't pay," the Tennessean reports.

Hospital companies say the more aggressive bill collection is necessary because "they can't afford to let even the smallest bills go unpaid" as the cost of care rises and "patients are responsible for paying more of their own medical bills," according to the Tennessean. Unpaid medical bills increased from $17.5 billion in 1995 to $28.8 billion in 2005, which corresponded with an increase in medical bills paid out-of-pocket by patients from $146.3 billion to $249.4 billion over the same time period.

However, patient advocates "say the practice can get out of hand, especially with people who have little insurance or high-deductible plans" and "can squeeze patients when they're at their most vulnerable," the Tennessean reports. Some hospitals have responded by offering discounts to uninsured patients who pay up front, on top of a charity care discount (Ward, Tennessean, 6/21).