Dive Brief:
- Some physicians and hospitals have begun to impose new fees on patients to make up for gaps in revenue created by lower insurance payments, according to the New York Times.
- In one example, a patient in Massachusetts who was seeing a therapist at a hospital was expected to pay not only the therapist's fee, but also a facility fee for the room in which the therapist provided the treatment.
- At hospitals, new emergency department charges are emerging such as "activation fees" which are piled on top of facility and service charges. One hospital reportedly charged a family $1,400 "ER fee" prior to the woman's induced delivery for spending a few minutes in a side room filling out forms. Another hospital in Aitkin, MS charged a family a $2,457 fee for "noncritical activation" of the trauma team despite the fact that the child only answered nurses' questions and had her head scanned.
Dive Insight:
In theory, the enactment of the Affordable Care Act was supposed to take some of the uncertainty out of getting care and help patients manage their expenses. But as these examples demonstrate, providers have an agenda of their own, one which doesn't necessarily fit with the objectives of health reform: Staying financially solvent.
Patients can't always be sure that basic health services will be covered, despite the fact that such coverage is required by the ACA. For example, while annual physicals are covered, some insurance companies are refusing to pay for some of the blood-work certain physicians consider standard. Or take women's health coverage: While an intrauterine device is covered by ACA policies, providers charge insertion fee.
Setting up a tug-of-war between insurance players, providers and patients is surely counterproductive. Let's hope providers on the front lines find other ways to stay solvent.