Zuckerberg hospital considers cost cap for privately insured patients amid billing uproar

Privately insured patients receiving emergency services at Zuckerberg San Francisco General Hospital could see a cap on out-of-pocket payments, according to a San Francisco Examiner report.

A cap is under consideration by San Francisco health officials amid a public spotlight on the hospital's practice of balance billing.

Balance billing occurs when privately insured patients receive trauma or emergency services from an out-of-network provider and are billed for the balance after the insurance company pays its portion.

Zuckerberg San Francisco General — renamed after Facebook founder Mark Zuckerberg and his wife Priscilla Chan, MD, donated $75 million to the hospital — is San Francisco's largest public hospital and houses a level 1 trauma center.

Although the hospital primarily treats Medicare, Medicaid and uninsured patients, it has been in the news since a recent Vox report revealed the hospital is out of network with all private health plans, which can leave patients with massive bills.

Balance billing is lawful in California for patients with preferred provider organization health plans, and as many as 1,700 privately insured patients incur significant out-of-pocket costs annually at Zuckerberg hospital, according to the San Francisco Examiner, which cites information reported Feb. 21 by the San Francisco Department of Public Health during a board of supervisors committee hearing.

"What we are proposing is to set a new policy that will limit the total amount that the [privately insured] patient has to pay based on a policy that takes into account the patient’s income," said Greg Wagner, CFO of the city's health department.

"Instead of the patient paying that whole balance, there would be a limit on how much we would bill the patient for care at Zuckerberg San Francisco General Hospital," said Mr. Wagner.

The San Francisco Examiner reported that San Francisco health officials are also looking at improving communications with patients about medical bills as well as overhauling procedures to assess whether a patient qualifies for financial support programs before billing the patient.

The proposals come after the hospital announced Feb. 1 that it would be halting balance billing for 90 days to finalize a plan to address billing issues in the long term.

Mr. Wagner said the cap proposal is a short-term solution and that hospital and public health leaders will also consider long-term policy changes.

 

More articles on healthcare finance: 

US health spending estimated to reach nearly $6 trillion in 8 years
National healthcare groups outline surprise-billing principles
California proposed health-pricing transparency bill would affect Kaiser Permanente

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