Healthcare News & Insights

ERs demand upfront payment

Don’t be surprised if your next ER visit requires an up-front payment before a doctor will see you. More and more hospitals are requiring patients who arrive at the emergency department without a true emergency to pay an up-front fee before they get treatment.

HCA, one of the largest for-profit hospital chains, has adopted such a policy. The outcome? More than 80,000 ER “patients” left the hospitals without being treated. How many left because of a lack of funds or from the realization that the visit wasn’t worth the $150 charge is impossible to say.

But HCA hospitals aren’t the only ones requiring cash before patients get treated. Fees can run as high as $350 a pop for the uninsured at some hospitals. And while it’s hard to argue that emergency medical care can’t be more efficient in general, not everyone agrees that this is a good way to handle patients.

Some ER docs and patient advocates say it hurts some patients, with little benefit to the hospitals. For example, patients with less serious illnesses are usually processed relatively quickly and without expensive tests or taking up needed beds.

What it does do is scare off the most indigent of the uninsured, who may have little other recourse for basic medical care. (Non-urgent patients with insurance would only have to pay their usual co-pay and whatever fees are associated with the treatment they eventually get.) Without timely treatment, uninsured patients may well end up back in the emergency department — this time with the type of urgent illness that allows them to bypass the “admission” fee.

Is it just plain good business to charge up-front fees for non-urgent care? Or is it just one more example of how the health system allows some people to fall through the cracks? Sound off in the comments.


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  1. Krystin Keller says:

    Well, it is about time that the hospitals start detering non-payment for non-emergent issues. I have had many a patient not come into our office and go instead to the ER because they have a balance with us and don’t want to pay. In my experience, there are quite a few of those people out there who use the ER as a doctor’s office because they feel that they can go and be seen and not have to pay anything. I have to pay when I go, why shouldn’t they? Meanwhile, people who do have to be seen and are willing to pay or have paid for the services through their insurance premiums suffer. Life is not free, and neither is healthcare! I think it is irresponsible for a hospital system to NOT charge a deposit up front for services! It creates a time crunch in the ER and forces patients who seriously need emergency care to sit and wait while others who should be at their PCP offices are seen for their diabetes or HTN issues. If you can’t pay for your non-emergency issue, then you need to seek care at a non-profit hospital that gets governmental subsidies to take on indigent care patients. Cudos HCA! May more for-profit hospitals follow in your wake.