Joint hospital effort offers help to self-pay patients

The New Hampshire Hospital Association has developed a program designed to help patients who fall into the expensive gap of earning too much money to qualify for public assistance yet have no health coverage.

Twenty-four of the state’s 26 acute-care hospitals — from the 330-bed Catholic Medical Center in Manchester to 25-bed Cottage Hospital in Woodsville — are voluntarily participating in Hospital Access Plus, a program that offers a 15 percent discount to patients who don’t have any health insurance and don’t qualify for other financial assistance.

“Our hospitals agree that the current system of billing in health care is outdated,” said Mike Hill, NHHA president. “Hospital Access Plus is a step toward addressing that issue for some of the approximately 120,000 New Hampshire citizens who don’t have any health insurance and don’t receive financial help from other sources.”

This program represents “the first time hospitals have worked together collaboratively on an initiative of this kind,” said Hill.

Insurance companies that cover many patients can negotiate lower prices on hospital services — essentially getting a price break on a volume purchase.

Patients who don’t have insurance pay at a higher rate than those who do because they do not receive the cost savings, which forces many to stretch to the limit their already thin dollars.

“The people who will be helped the most by this program are typically employed but don’t have access to insurance through their employer or can’t afford insurance. They have no choice but to be uninsured,” said Hill. “This program is for those without insurance, regardless of their financial situation.”

An application is not required for Hospital Access Plus, and the discount is automatically applied when criteria for federal, state or community-based financial assistance programs are not met.

The only major caveat is that the discount is only applied to the hospital portion of the bill. The bill for a hospital stay has essentially two portions — one for hospital services and another for fees charged by physicians or other providers, who often are not hospital employees and structure their charges independently of the hospital.

The discount also applies only to those services deemed “medically necessary.”

“But,” said Hill, “you don’t see many patients in this type of situation going for some unnecessary cosmetic surgery.”

Hospitals usually try to work with patients offering discounts or some sort of structured payment over time. But often those considered “self-pay” can’t pay, forcing the bill into collections — and adding to the cost for both the patient and the hospital.

Last year, New Hampshire’s 26 hospitals wrote off over $153,226,533 in bad debt and another $113,238,471 in charitable debt, absorbing these costs into care. On average, self-pay patients represented about 5 percent of total discharges in 2005 for New Hampshire’s hospitals, but for some hospitals that figure could be twice as high.

Absorbing bad debt also can have a trickle-down effect of forcing a hospital to raise prices and passing those greater costs onto those who do have means to pay. This may, in turn, force insurance companies to raise their own prices on premiums to consumers.

Even though hospitals are extending a 15 percent discount, they may actually save some money, said Hill, by avoiding sending patients to a collections agency.

The 24 participating hospitals are:

• Alice Peck Day Memorial Hospital, Lebanon
• Androscoggin Valley Hospital, Berlin
• Catholic Medical Center, Manchester
• Cheshire Medical Center, Keene
• Concord Hospital, Concord
• Cottage Hospital, Woodsville
• Dartmouth-Hitchcock Medical Ctr., Lebanon
• Elliot Hospital, Manchester
• Exeter Hospital, Exeter
• Franklin Regional Hospital, Franklin
• Frisbie Memorial Hospital, Rochester
• Huggins Hospital, Wolfboro
• Lakes Region General Hospital, Laconia
• Littleton Regional Hospital, Littleton
• Monadnock Community Hospital, Peterborough
• New London Hospital, New London
• Parkland Medical Center, Derry
• Portsmouth Regional Hospital, Portsmouth
• Southern New Hampshire Medical Center, Nashua
• St. Joseph Hospital, Nashua
• Speare Memorial Hospital, Plymouth
• Weeks Medical Center, Lancaster
• Wentworth-Douglass Hospital, Dover

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