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Healthcare: Right, Privilege or Service?

August 5, 2008
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A few weeks ago a well known rap artist was arrested for using someone else’s name at an ER visit in order to avoid paying the bill. It really prompted me to wonder why someone making large sums of money would try to commit fraud to avoid paying a bill. Isn’t this the same as shoplifting? Is there a cultural shift in our society that looks at healthcare as a right? Does the debate for national healthcare contribute to this mindset? I know that major academic medical centers still write off patient accounts, do not send patients to collection agencies and continue to see patients with large overdue balances. So are we contributing to the impression that a healthcare bill is very different than an automobile repair bill? We may in fact be contributing to that cycle by charging patients that can pay (or their insurance) and writing off balances on those that can not.

I have never met a humanitarian auto mechanic. Very few mechanics are willing to place their customers on a payment plan and if they can not pay their bill, they would rather write off the balance than deny service. Those working in the healthcare industry realize that at the end of the day, we provide a service for the greater good. I have met some really wonderful people with great hearts. But I have also seen my share of closures, reductions and mergers due to poor financial performance.

So we tend to send mix signals to our patients. We are getting better at capturing information at point of care, electronic verification of coverage and many other tools to improve the revenue cycle. But are we ready to put up signs stating that “Shoplifters will be prosecuted?” Maybe healthcare is a right for some patients, a privilege for few and a service for all. But are we capable of meeting the needs of all?



Healthcare is a service. Recently my daughter had her wisdom teeth out, the Oral Surgeon advised me of the up front payment required and calculated my balance prior to the procedure, and I paid it. The Dentists, Eyecare and Pharmacists have it down in collecting patient balances prior to delivering the service. We could learn a lesson from them.

try this one on for size I recently had to visit the ER after being stung by a wasp and getting a forearm like Popeye. After being visited by someone who took my insurance information, another gentleman came over and said "mr. guerra, we ran your insurance and your co-pay today will be $75. Will that be cash or charge?"

"Uh, charge, I guess"

First time that ever happened to me in my life. I guess some hospitals are getting better at getting some green while they still have you in their clutches. Funny thing is that they have a ton of leverage over you BEFORE you leave. All told, I was in the ER for about four hours and that's WITHOUT any dispute over the bill. If I had asked them to bill me, I wonder if it would have taken another two hours to leave.

Bottom line, healthcare is not a right it's a service that has to be paid for whether you want it to come out of your paycheck in the form of taxes or your wallet at the point of care, you've got to pay because the people that give you care have to get paid.

Sounds like they have either revamped their revenue cycle or implemented a good eligibility checker. I am curious what others have experienced in similar situations.