A Publication of WTVP

On July 16, the U.S. House of Representatives Energy and Commerce Subcommittee on Oversight and Investigations launched a formal review into hospital billing and collection practices by sending a seven-page letter to 20 hospitals and health systems across the country. This congressional review has generated additional stories in various media across the country, including the Wall Street Journal and the Chicago Tribune. Most of those stories focus on patients who received health care services but were unable to pay for those services because they were uninsured.

All of us involved in health care today, whether a religious-sponsored or community-sponsored organization, are very concerned about how to best provide care for those who are uninsured and, secondarily, how to garner payment for those services. Generally, federal law and regulations seek to ensure a hospital charges all patients receiving the same services the same price. Additionally, hospitals are expected by the government (the Centers for Medicaid and Medicare Services) to make repeated efforts to collect on patient bills. In other words, if hospitals aren’t diligent about collecting for our services, our payments from Medicaid and Medicare are potentially at risk.

OSF Healthcare System has been providing health care to patients throughout Illinois, southern Wisconsin, and the Upper Peninsula for more than 126 years. When the Sisters first started caring for patients back in 1877, they didn’t even formally charge for their services, but accepted gifts of money and goods from those who felt very indebted to the Sisters for their wonderful care. Since that simpler time, OSF Healthcare System has put into place charges for the numerous and various services we provide patients in our hospitals, outpatient centers, emergency departments, physician offices, and our patients’ homes.

We have in place a charity policy for patients and families who may be uninsured, under-insured, or self-employed. Upon registration, if a patient or the patient’s guarantor informs us she or he is either uninsured or self-employed, the patient is immediately informed about OSF’s charity policy and offered an application. As one of the factors for calculating the amount of the discount provided those in need of charity care or financial assistance, we use the federal poverty guidelines. Applying for the charity care upon registration affords the patient and guarantor peace of mind, knowing a workable payment plan will be developed according to their capabilities to pay-or not pay, in some cases.

For patients who have insurance but have a difficult time meeting their obligation of the charges for the services provided, financial assistance is still available. The patient or patient’s guarantor has to submit an application, which is then reviewed by the financial assistance committee, to determine the most appropriate level of assistance-the discount that should be applied to the patient’s outstanding balance. In the past fiscal year, many patients applied for either charity care or financial assistance of some type, which contributed to OSF Healthcare System providing more than $62 million in uncompensated care.

Policies similar to those of OSF are commonplace among hospitals in Illinois and throughout the United States. So the next time you read or see a story about a hospital being accused of unfairly trying to collect for services rendered to an uninsured or under-insured patient, you’ll know "the rest of the story," as Paul Harvey would say. IBI