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Access has 'very liberal, very fair' self-pay policy
Discounts automatically given
Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare, says that her department has put a "very liberal, but very fair, uninsured payment policy in place."
"We looked at our three best contracts and took an average of them," says Braveman. "Anyone who has no insurance at all is going to get the same discount that we give to an insurance company."
There was a perception that hospitals were being unfair to uninsured patients by not offering them the same discount that insurers received, Braveman explains. "We have a policy in place where every single uninsured patient gets what we call an uninsured adjustment, just like we have Medicaid adjustments," says Braveman.
The hospital's discount policy is a sliding fee scale based on total household income and total number of dependents in the household, says Braveman. "So someone who is making a decent enough living, but has eight children, might still be eligible for some part of the bill to be discounted," she says.
The automatic uninsured discount is applied to the patient's bill before it ever goes out the door, says Braveman. "So the very first time the patient sees a statement from us, they can see the total charges, the uninsured discount, and the total amount due," she says.
The bill also states, "If you feel you are unable to pay this bill, please call this number to discuss other opportunities."
"We are really working with our uninsured and underinsured," says Braveman.
Deductibles are issue
One of the challenges that Braveman encounters with the underinsured population is the question of discounting deductibles. "It's something that we all struggle with. We recognize that you really shouldn't be discounting deductibles," she says.
Braveman gives the example of an employer which has negotiated a plan for their employees, with a premium cost of a certain dollar amount per month or year, based on the employee having a $5,000 deductible. "If you discount that $5,000, then you've kind of gone outside all of the contracts and negotiations that have occurred," she says.
Instead of this discount, the department has taken other steps to make it easier for patients to manage their high deductibles. "We have some really nice payment plans that we allow people to go on. We do not charge interest," Braveman says.
She has talked to some of her peers who have begun to work with medical credit card companies. "We have not gone that route. I feel that then you become more of a bank. I'm not looking for that at this point," Braveman says. "We might have somebody paying $50 a month for three years. As long as they keep those payments coming in, I'm fine."