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Uninsured Will Get 25 Percent Discount in North Carolina Health System

Posted on: Wednesday, 20 July 2005, 00:00 CDT

Jul. 19--CHAPEL HILL -- Starting Aug. 1, uninsured patients seen by UNC Health Care system will receive a 25 percent discount on physician and hospital care, regardless of their income.

It's UNC's response to the unfolding national debate about how forgiving hospital financial policies should be, particularly with the uninsured. The state-supported system's board of directors unanimously approved the discount Monday.

"It's our way of acknowledging that the people with the least ability to pay are the only ones routinely asked to pay full price," said Dr. Allen Daugird, the UNC system's vice president for ambulatory services. People with health insurance receive a reduced rate negotiated by their insurer.

Directors also approved changes that will give additional price breaks to both insured and uninsured UNC patients with limited incomes.

Beginning Jan. 1, UNC will expand eligibility for charity care so that more North Carolinians will qualify for free care after they make a co-payment. Under the new policy, a family of four with an income of up to $48,375 would qualify, whether they have insurance or not. The current income limit is $38,700. A patient with insurance would have only their portion of the bill waived.

Eligible patients should no longer receive collection notices and menacing calls, since UNC will have determined up front that they cannot afford to pay, said Daugird, who headed the committee that wrote the policy.

Dr. William L. Roper, UNC Health Care's chief executive, said he does not expect the discounts to substantially change what the system pays now. That's because many people who will qualify for discounts are not paying their bills now and are counted as "bad debt." Last year, the total amount UNC spent on charity care and bad debt was about $88 million.

To qualify for charity care, UNC patients will be required to provide detailed financial information, usually before receiving care. UNC will not turn away patients who can't pay, though people with nonemergency medical needs may face delays, Daugird said.

The new charity care policy will be in effect for UNC hospital and physician services, with the exception of cosmetic procedures and other care not deemed medically necessary. Rex Healthcare, which is part of the UNC system, has its own charity care policy.

The policy is significantly less generous than the one UNC originally proposed in May.

That plan for a sliding scale discount would have allowed a family of four with health insurance and annual income of up to $96,750 to receive a 40 percent discount off their share of the bill. Patients with lower incomes would have received larger discounts or nearly free care.

UNC scaled back the proposal based on feedback from community health centers, other academic health systems, insurance companies and others. Daugird said insurers felt the more generous proposal exceeded the community standard for charity care and might violate UNC's contracts with insurers, which require the system to make a good faith effort to collect copayments, deductibles and coinsurance.

Adam Searing, a health-care advocate for the poor and uninsured, said he would have liked to see UNC retain its original, more generous proposal. Recent research from Harvard University noted that about half of all personal bankruptcies are triggered by large medical bills. Most of the people who filed had health insurance, the Harvard researchers found.

"I'd like to see those people get some help," Searing said. "But if you're doing triage and you're forced to choose, I'd go with the people who are poorest. They're the ones we need to focus on first."

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Source: The News & Observer

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