How do hospitals deal with unpaid bills from patients

First money, then help - that drives seriously ill people to ruin

Cash before Chemo: Hospitals Get Tough was the headline of a Wall Street Journal article that described the case of a 52-year-old leukemia patient. In 2006 she asked for treatment at the renowned cancer hospital M.D. Anderson in Texas tried hard.

However, the hospital found their insurance inadequate - the policy stipulated a maximum annual payout of $ 37,000. She asked for $ 105,000 upfront for diagnostic and therapeutic measures. Although the hospital later moved away from these high numbers, the patient complained of an ongoing battle with house collectors during the course of her treatment.

Many clinics only treat after prepayment

It was similar with a retired landscape designer, whose misery was described in an issue of the AARP Bulletin (American Association of Retired Persons): He too had been diagnosed with cancer and had been referred to a special hospital. An upfront payment of US $ 20,000 was required for his treatment. Since the patient had used up the savings for cancer treatment for his wife, who had since died, he was unable to raise this amount. At the time this article was published, he had already known about his illness for three months, but had not yet found any alternative treatment.

Although these examples are individual fates and it has not yet been statistically proven how many people are affected, there is a trend: For example, in 2006 the US tax authorities asked non-profit hospitals for the first time about their billing practices. It was found that 14 percent of the 481 responding hospitals demanded advance payments or the conclusion of an installment payment agreement in advance.

Those who have insurance are also affected

An unrepresentative survey of 22 Florida hospitals found that all require advance payments for elective surgery, the South Florida Sun-Sentinel reported.

The dilemma of prepayments is another indication that the US health care system is sick: meanwhile, it is no longer just the 47 million uninsured who are at risk of losing everything if they are seriously ill. Increasingly, those who are insured are also affected, but whose policies require additional payments that overwhelm them in the event of serious illness. The result is an increase in unpaid bills, which in turn place service providers in precarious situations. According to the American Hospital Association, American hospitals were left with roughly $ 31.2 billion in unpaid bills in 2006 - a 44 percent increase over 2000.

It makes sense to talk to patients about financial obligations in advance, said a representative of the M.D. Anderson Cancer Centers. Before the treatment, the patients are "ready" on this point. The hospital still often treats poor patients free of charge, it said. In the case mentioned, however, it was not a penniless patient. Penniless or not, the American Cancer Society says it is receiving more and more calls from patients seeking advice. "I fear that there are a significant number of people who have cancer but are not treated - mostly for financial reasons," said Otis Brawley, chief medical officer, the Wall Street Journal.

US patient rights in the clinic

US hospitals are required by law to treat emergency patients regardless of their insurance status. But where life and death are not directly involved, the service providers generally walk a tightrope between business and humanitarian considerations. Since US citizens have to take care of their own insurance coverage, it often happens that they have policies that are too low to be able to pay for expensive cancer therapy in an emergency, for example. This is because treatment is considered elective, although delaying it can drastically reduce life expectancy.