Many Texas nonprofit hospitals send patients bills before checking whether they qualify for free or discounted care, and most won’t refund what patients pay in the meantime, KFF Health News and Tradeoffs reported Oct. 15.
The outlets reviewed financial assistance policies from 166 nonprofit general and children’s hospitals in Texas. Forty-four percent said they will bill patients before screening them for aid, and some send multiple bills or use collection agencies first. The most common approach is to screen only before “extraordinary collection actions” such as wage garnishment or selling patient debt.
Only one system, Houston-based Memorial Hermann Health System, has a written policy requiring its hospitals to reduce or erase bills before patients are billed, according to the report.
Billing first means some patients pay before they learn they qualify. Only 10 of the 166 hospitals guarantee those patients a full refund, according to the report’s findings. Most others say they won’t return money patients paid before being screened, beyond what federal rules require: a refund of any amount paid above what the hospital typically charges insured patients.
Patients whose bills are erased don’t always find out. Irving, Texas-based Christus Health, Arlington-based Texas Health Resources and Texas hospitals owned by Chicago-based CommonSpirit Health don’t notify patients when debt is forgiven automatically. Christus and Texas Health Resources did not respond to interview requests about their policies, and a CommonSpirit spokesperson declined an interview. A March study in the Journal of General Internal Medicine found adults with medical debt were significantly more likely to delay medical, mental health and dental care than those without it.
The investigation also found that eligibility for automatic screening varies widely from hospital to hospital. Some policies were hard to find, even though federal law has required nonprofit hospitals to publicize them for more than a decade.
Read the full report here.
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