You can file the follwing news in your predictable folder. High-deductible insurance plans are causing billing problems for hospitals (see: High-deductible plans change how hospitals interact with patients). Below is an excerpt from the article:
High-deductible plans are changing the way health systems interact with their patients, from where they get care to how they're presented with their bills....Healthcare providers are collecting $0.18 to $0.34 on the dollar from patients with high-deductible plans....Once a bill exceeds 5% of household income, a patient's propensity to pay drops to nearly zero....The average deductible for employer-sponsored coverage is now at $1,200, and it's even higher for exchange plans....[At least one hospital] has introduced a 25% prepayment policy for self-pay patients as well as those who will owe more than $1,000 or 20% of the cost of their scheduled procedures. Vendors, too, are offering products that will allow providers to have financial conversations with patients before any care is delivered. At the meeting, technology company Simplee announced that it is expanding its online payment platform to include tools that allow patients to get real-time, pre-service cost estimates and then explore financing options. While health systems are taking different approaches, more providers are initiating financial conversations before treatment begins, including financial literacy education....The MetroHealth System in Cleveland is among the systems that hasn't seen an increase in bad debt associated with high-deductible plans. But commercial plans account for only 22% of the county-owned system's revenue....Moreover, Medicaid expansion in Ohio has reduced the number of self-pay patients to 6% in 2014 from 18% in 2012. But MetroHealth is fielding more calls from patients with questions about their bills.
So we now see hospitals requiring partial prepayments and providing online payment platforms in order to improve their collections. Hospital executives should have been able to anticipate this problem as employers shifted to high-deductible plans to decrease their healthcare costs. Who would have thought that employees would be better able to bear these costs than the companies that employed them?
Hospital billing systems are a mess (see: Two Reasons Why Medical and Hospital Bills Are Such a Mess). As I pointed out more than six years ago, the prices charged by hospitals are also largely irrelevant and designed mainly to manage reimbursement from the health insurance companies when they covered most of the bills (see: Why the Prices Charged by Hospital for Inpatient Care Are Irrelevant).
We are moving away from a system under which health systems negotiated discounts with the insurance companies. So here's how I would characterize the hospital side of "conversations" with patients prior to admission: (1) we are not exactly sure what the cost of your procedure will be; (2) we can't present the billing data to you in a way that you will understand; (3) we also can't present data to prove that the quality of our services is superior to that or our competitors. Please tell us how you intend to pay for your share of the bill under your high-deductible plan.
Topics that should be entering into these patient discussions are value and transparent pricing that have not previously been on the table. Starting with complex surgical procedures, there should now be major movement toward hospitals that offer patients (and their health insurance companies) a fixed, highly competitive price quote for a surgical procedure. In such an environment, it does not seem unreasonable for the hospital to request prepayment of some portion of the patient's share of the bill.