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Health Care Reform:

Health Insurance & Affordable Care Act

Rethinking Charity For Those Declining Coverage


Many hospitals are simply checking to see if their policies comply with the health law’s requirements, says Todd Nelson, a director at the Healthcare Financial Management Association, which represents more than 40,000 people who work in health care finance.

He is not surprised that some require applicants to apply for insurance coverage.

“Hospitals have always encouraged patients to apply for coverage they are entitled to receive, whether commercial insurance through employer or through programs like Medicaid,” he says.

Tenet, HCA Make No Changes

Several hospital chains, including two of the largest -- Tenet and HCA -- say they don’t have plans to change their charity care policies. Both offer free care to those who meet certain requirements, including earning less than twice the federal poverty rate.

While many charity care programs have been in place for decades, others were established following widespread complaints and lawsuits brought in the late 1990s over aggressive hospital collections tactics. Those included placing liens on patients’ homes and charging the uninsured the highest list prices, which were far more than what insurance companies paid on behalf of policyholders.

Now, under the health law, nonprofit hospitals must make reasonable efforts to determine if patients qualify for help before taking tough collection tactics. And the law says the amount sought from the patient cannot be the hospitals’ list price, but an amount closer to what is generally billed to insured patients.

The big benefit from the health law is that it requires hospitals to make their charity policies public, says Mark Rukavina, an expert on medical debt who consults for hospitals.

“The ACA’s requirements will improve transparency dramatically,” he says.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Fri, Aug 15 2014

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