Billing revamp expected to cost Zuckerberg hospital up to $2.2M in lost revenue

Zuckerberg San Francisco General said it anticipates losing  $1.9 million to $2.2 million in revenue annually as a result of changing its billing practices, according to the San Francisco Business Times.

The hospital — which is San Francisco's largest public hospital and houses the city’s only level 1 trauma center — is updating its billing practices after its balance billing policy made headlines.

Balance billing occurs when a patient receives services from an out-of-network provider and is billed for the difference between what the patient's insurer pays and what the provider determines the care is worth.

Under new policies, balance billing will be discontinued at the hospital. Zuckerberg also will no longer bill privately insured patients receiving out-of-network care at the hospital more than they would pay at an in-network hospital for the same care.

The changes will cover more than privately insured patients. The hospital said it will set income-based, maximum out-of-pocket costs for patients at all income levels, regardless of insurance status, and will make its patient financial assistance programs more accessible and easier to qualify for.

"It came to our attention that some of our billing practices were not really consistent with the values that we have as an organization, which is a community resource," Susan Ehrlich, MD, CEO of Zuckerberg hospital, told the Times. "What we're focusing on now is making sure that individuals don't get big bills."

But the billing and other policy changes are projected to result in a loss of $1.9 million to $2.2 million in annual revenue for the hospital.

Vox report in January revealed the hospital was out of network with all private health plans, which had the potential of leaving patients with massive bills.

Now the hospital is looking to forge deals with private insurers for select departments, such as gynecology and obstetrics, said Dr. Ehrlich, who acknowledged the complexities of contracting with those insurers.

Usually, private insurers offer the promise of lots of patients in exchange for discounts on payments to the hospital, she told the Times. But Zuckerberg, which treats mostly Medicare, Medicaid and uninsured patients, lacks the capacity to handle the large volume of patients private insurers want.

 

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