FAIR PRICING FOR THE UNINSURED CERTIFICATION AND COMPLIANCE PROGRAM

Background

• Since 2001, the Consejo de Latinos Unidos has been the leading national non-profit advocacy organization that investigates and documents cases of hospital price gouging of the uninsured. Typically, hospitals charge the uninsured three or four times as much as they would accept as payment in full from an insurance company. The Consejo has published six reports on hospitals.
• In 2003, the Consejo forced Tenet Healthcare, the nation’s second largest for-profit hospital system, to end price gouging of the uninsured. Tenet now offers the uninsured, regardless of income, the same discounted prices as managed care patients.
• In February of 2004, then U.S. Secretary of Health and Human Services Tommy Thompson rebuked the American Hospital Association, which alleged that federal regulations prevented its members from offering discounts to the uninsured, writing clearly and unequivocally, “Nothing in the Medicare program rules or regulations prohibit such discounts.”
• In October of 2005, the Daughters of Charity Health System in California adopted a discount pricing policy that offers all uninsured patients, regardless of income, the same deeply discounted rate equal to the “major” insurance provider at each of its hospitals.
• In the past week, important members of the U.S. House of Representatives, the U.S. Senate and the Bush Administration have raised concerns about “meaningless” hospital prices.
• The Consejo has assisted over 7,000 uninsured families and continues to receive, on a daily basis, complaints about hospital price gouging and aggressive collection tactics.

The Growing Need for a Certification and Compliance Program

• Since 2003, the issue of hospital price gouging has haunted the hospital sector at a national level. The reaction by some leaders of various federal and state hospital associations has been an arrogant attitude of denial and defiance.
• The political scrutiny that has evolved of late is a reaction to the foot-dragging and weasel-wording by some hospital leaders. In essence, hospitals in the United States have been greatly disserved by their trade groups like the American Hospital Association.
• Some hospital insiders and executives are upset with the leadership of the American Hospital Association (AHA). Many believe the AHA has fueled the controversy, provoked additional Congressional inquiries and investigations, and inspired state Attorney Generals to probe the tax-exempt status of nonprofit hospitals. Some disgruntled hospital executive want an amiable end to the controversy.
• Although the American Hospital Association will boast of how at least 4,500 hospitals have discount policies in place, many of these same hospitals do not inform their public or uninsured patients about their policies. What good is a discount policy if it is sitting in a desk drawer?
• Uninsured patients have no where to go to view the discount policies and to understand if they truly are “fair pricing” policies. The public relations induced guidelines that hospitals have adopted in many cases do little to help the uninsured. The hoops, loops, jumps, and skips of some of these bureaucratic, paper-filled discount policies are designed to benefit the hospital.
• The so-called financial aid application is unfortunately used by some hospitals to determine assets and attempt to coerce uninsured families to pay outrageous high prices for services rendered

The Uninsured

• A national study last year acknowledged that “many hospitals have modified billing and collection practices for low-income, uninsured patients.” The reality is those are people the hospitals cannot get anything from anyhow.
• The real victims of hospital price gouging, aggressive billing, and ruthless collectors are uninsured families of “moderate means” who are not poor enough to qualify for government aid or charity care, but are not wealthy enough or healthy enough to own private insurance.
• These uninsured families may own a home, have a decent paying job, or a college savings account for their children. Some hospitals target these hard-earned assets.

Our Objectives

• To begin a dialogue with individual hospitals, health systems, hospital associations, and affiliated groups to reaffirm or establish fair pricing policies for uninsured patients.
• To establish an electronic clearinghouse on the internet where uninsured patients can view actual fair pricing policies for uninsured patients of hospitals from across the country.
• To monitor hospitals and verify if they are complying with and informing uninsured patients about their discount and fair pricing policies.
• And most importantly: To bring to an end the ugly era of hospital price gouging of the uninsured and restore public confidence in the hospital sector.

 
 

Our Commitment to Hospitals

Consejo de Latinos Unidos is committed to working with hospitals who wish to restore the public trust and offer fair pricing to the uninsured. Everything is on the table to be negotiated in the best interests of the uninsured, local community, and the hospital.

Basic Discount Policy Guidelines Open to Discussion

• All uninsured patients, regardless of income, will be charged a fair rate. Either

1. the lowest managed care discounted rate (most deeply discounted plan), or
2. the largest managed care provider discounted rate (i.e. Blue Cross), or
3. the average managed care discounted rate (weighed proportionately), or
4. Medicare rate plus 25 percent , or
5. a percent discount that is equal to or near the average discount given to all insured patients according to Medicare, or
6. an alternative rate determined by the individual hospital or health system and the Consejo that provides the uninsured with fair pricing.

• Reasonable payment plans will be offered and the only difference between a prompt pay and month-to-month plan will be nominal interest charge and/or a monthly administrative fee.

• No uninsured patient will be sued or sent to collections until the hospital has offered a discounted pricing plan. If the patient refuses to pay or defaults on a discounted pricing payment plan (misses two or three payments), then the hospital can send the person to collections or sue.
• No uninsured patient will be sued if the only asset the patient has is the family home.
• Hospitals will individually determine and define the scope and qualifications for patients to qualify for charity care (free care typically provided to patients at or below 200 percent of the Federal Poverty Level). All uninsured patients will be informed in writing about charity care and where to apply.
• Uninsured patients will have an “opt-out” option and not have to fill out any charity care paperwork if they wish to simply pay the discounted price.
• Consejo will periodically run radio or print ads in a hospital’s market. Any complaints during that time or anytime during the year will be sent directly to the hospital for resolution (what we currently do for Tenet and Daughters of Charity).
• Consejo will in good faith defend hospitals that have good standing.
• Consejo will discourage litigation from trial attorneys and if necessary file a friend of the court brief on behalf of a hospital in good standing.
• Hospitals will regularly brief and train admissions and patient financial services employees about their discount policy.
• The basic discount policy will be posted in public areas and all patients will be told in writing about the policy or where to get discount policy information before they are discharged.