Nearly half (44%) of nonprofit hospitals in Texas say they will send patients a bill before checking whether they qualify for free or discounted care, Tradeoffs reported Oct. 1.
The nonprofit newsroom reviewed the presumptive eligibility policies of 166 nonprofit general and children’s hospitals across the state. Presumptive eligibility lets hospitals screen patients proactively and automatically reduce or erase their bills, without the patient having to apply for financial assistance. The analysis is part of Hidden Help, an investigative series from Tradeoffs and KFF Health News.
The findings come as Texas policymakers weigh legislation that would require nonprofit hospitals to use presumptive eligibility before billing patients.
Here are three things to know from the analysis:
1. Timing of screening varies widely. Some hospitals screen after one bill. Others may send several bills and bring in collection agencies before checking eligibility. The most common approach is screening before “extraordinary collection actions,” such as wage garnishment, selling debt to a collector or withholding further care until outstanding bills are paid.
2. Few hospitals guarantee full refunds. Only 10 of the 166 hospitals promise a full refund to patients later found eligible for aid. Most say they will not return money paid before screening.
3. Many patients are not told their debt was forgiven. Some of the state’s largest nonprofit systems do not notify patients when their bills are automatically written off.
Anna Stelter, vice president of policy at the Texas Hospital Association, told Tradeoffs that hospitals want to identify other sources of payment, such as Medicaid or county safety-net programs, before offering financial assistance. “Charity care is the relief of last resort,” she said.
The Texas Hospital Association shared the following statement with Becker’s Oct. 2:
“Texas hospitals put their patients first and provide billions in free and discounted care to people who can’t afford it. We have one of the strongest charity care requirements in the nation, and this is one way we help protect vulnerable Texans from medical debt. These are deliberate investments for patients regardless of their ability to pay and help increase access to care across the board for Texans.”
