More patients asked to pay first

Unpaid bills lead to tougher policies

The next time you go in for care at UNC Hospitals or any of its outpatient clinics, don't forget your wallet.

Hospital workers are beginning to ask patients who come in for non-emergency care to pay their portion of the bill up front, usually when they check in for medical appointments.

Some may balk at paying for treatment they have yet to receive, but many hospitals say it's necessary because too many patients don't pay their share. Unpaid bills have mounted in recent years, and hospital administrators worry that will only worsen as health insurance becomes less generous and patients become responsible for more of their own medical bills. Patient fees now frequently make up a quarter or more of hospitals' total reimbursement for some services.

"You can't ignore that. It's the difference between covering expenses or not covering expenses," said Dr. Allen Daugird, UNC's vice president for ambulatory services, who is leading the initiatives.

UNC's efforts appear to be paying off. In the fiscal year that ended June 30, UNC Hospitals had operating income of $8.6 million on revenues of about $615 million, instead of an expected loss of about $870,000.

Privately insured patients who have endoscopic procedures at UNC Hospitals, for example, are now asked to pay $250 -- 10 percent of the average hospital and physician charges -- upon registering. The rest of UNC's clinical departments will begin collecting similar payments over the next 12 to 18 months.

Steven Weisenhauer, who had a colonoscopy at UNC last week, didn't object to paying the $250 charge. The materials UNC mailed before the appointment specified that he'd be asked to pay, so he was prepared.

"If they send the letter out ahead of time, people know what they're getting into," Weisenhauer said.

His wife, Diane Weisenhauer, even saw paying up front as a positive. "It's better to pay it now rather than getting the bills later and letting them stack up," she said. "You're going to have to pay it sooner or later."

For now, UNC isn't turning away patients who decline to pay up front. But in the future, UNC might ask them to delay treatment until they are prepared to settle up, Daugird said. UNC Hospitals is not asking for payment up front in the emergency room -- that would be a violation of federal emergency-care law -- but patients seen in the ER are asked to pay their portion of the bill when they are discharged.

"People have the impression that we're money grubbing and we're mean," Daugird said. "But when you go to get your driver's license, you can't say 'Send me a bill.' If you don't pay, you don't get your driver's license. The reality is, the longer you wait to collect, the less chance you have of collecting anything."

Duke also collecting

UNC isn't the only hospital getting more aggressive.

Duke University Health System has made collecting when patients come in for treatment a priority over the past 18 months, and is expanding the practice at its clinics. WakeMed in Raleigh is also intensifying up-front collections, installing a new computer program that will make it easier to more accurately assess patients' financial obligations.

Most physician practices have long expected patients to pay copayments when they come in for care, either when they check in or before they leave the office. Some clinics of UNC Physicians & Associates, the faculty medical practice affiliated with UNC Hospitals, have required up-front payment for years, Daugird said.

Still, some at UNC are uncomfortable with UNC Hospitals' new emphasis on getting paid.