PPH considering new financial assistance policies

By: ANDREA MOSS - Staff Writer | Wednesday, September 5, 2007 1:01 AM PDT ∞

ESCONDIDO -- Proposed bill-discounting policies at Palomar Pomerado Health could reduce the rates uninsured patients pay for hospital services by up to 40 percent, according to information given to a key Palomar Pomerado Health committee Tuesday.

Some middle-income patients who have health insurance could also see their hospital bills reduced under the proposals. And patients who meet certain federal poverty guidelines could ask the district to write off their entire bills.

The policies, which still must be approved by hospital administrators, were laid out during a Palomar Pomerado Health finance committee meeting at the public hospital district's supply warehouse on Enterprise Street The health care district operates Palomar Medical Center in Escondido and Pomerado Hospital in Poway.

Marianne Van Winkle, a revenue manager for the health care district, told the committee the proposed policies would enable the district to comply with state Assembly Bill 774.

Signed into law last year, AB 774 is designed to keep hospitals from charging uninsured patients higher rates than insurance companies, Medicare or other government programs pay for similar services.

Palomar Pomerado already offers financial assistance to some of its patients and writes off some bills that go unpaid.

Assembly Bill 774 requires hospital districts to establish written financial assistance policies that cover more categories of patients and procedures for implementing those policies.

The financial assistance proposals discussed Tuesday would cover three groups of patients.

  • Low- and middle-income patients who earn 350 percent or less than the federal poverty guidelines would qualify. Uninsured people who earn 250 percent or less than the federal guidelines could ask the district to write off their entire bills. Calculations by Van Winkle's staff showed a family of four whose annual household income was $51,625 or less would qualify for that type of financial assistance from the district, she said.

    Patients who fall into the same financial category but have health insurance could get financial help with their share of their hospital bills, under the program.

    And uninsured patients earning between 251 percent and 350 percent of the federal poverty guidelines could request discounts that would reduce their bills to levels equal to Medicare's reimbursement rates, Van Winkle said. A family of four with an annual household income of $51,626 to $72,275, for example, would be eligible for such discounts, according to information provided at the meeting.

  • Uninsured patients who make too much money to qualify for the financial assistance program would also be eligible for discounts. Patients in this category could have their own bills reduced by 10 percent to 40 percent, depending on the payment method used and how quickly the bills were settled. Cash payments, for example, would cut those bills by 10 percent, while settling the bill within 30 days would an additional 30 percent "prompt pay discount."

    Combined, those two discounts would lower the district's rates so they were comparable to the negotiated rates paid by MediCare, said Bob Hemker, chief financial officer for the district.

    MediCare and private insurance companies often make deals with hospitals requiring them to pay less than full rates. The new rules will be designed to level the playing field for the uninsured, Hemker said.

    "What you see ... is an effort to make it more equitable across the board," he said. "Basically, what this does is it established a negotiated contract with self-paying people. And if they breach that contract, (their bill) then goes back into the 100 percent category."

    Those unable to pay within 30 days could still have their bills reduced by 20 percent if they signed up for and adhered to the terms of an extended payment plan offered by the district.

  • Undocumented immigrants would also be eligible for assistance.

    Palomar Pomerado has received about $2 million since 2005 under a federal program that helps hospitals cover the costs of treating illegal immigrants. The proposed policies call for the district to submit quarterly requests for reimbursements from the government.

    Patients would have to fill out written applications for any financial help before they could receive it. Van Winkle said she and Cindy Burns, patient services manager for the district, are working to set up training designed to make hospital staff members aware of the proposals and help them understand how they would work, so they can help patients request financial assistance.

    Committee members questioned whether the policies might hurt Palomar Pomerado's bottom line. Van Winkle and Hemker, chief financial officer for the district, said that was unlikely because the district currently pays a collection agency to follow up on unpaid bills -- often with little or no success in getting the money owed.

    Offering patients the chance to pay reduced amounts, on the other hand, seems to work better, they said.

    -- Contact staff writer Andrea Moss at (760) 739-6654 or amoss@nctimes.com.

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    Pre-Registration Comments[-]Go to Top

    Free treatment for illegal immigrants wrote on Sep 5, 2007 7:28 AM:"Undocumented immigrants would also be eligible for assistance. Palomar Pomerado has received about $2 million since 2005 under a federal program that helps hospitals cover the costs of treating illegal immigrants." I guess PPH feels it's ok as long as they make a profit on treating illegals. I hope everyone has figured out that we (legal citizens) are the ones paying for this. The federal program paying PPH to treat illegal immigrants comes from our tax dollars. The illegal immigrants money gets sent back to their own countries.

    Illegal Alien Assistance Illegal? wrote on Sep 5, 2007 7:30 AM:Federal immigration law (8 USC 1621) already in effect declares that an illegal alien is not 'is not eligible for any State or local public benefit.' How does PPH's new policy square with Federal immigration law?

    Mike in Escondido wrote on Sep 5, 2007 10:06 AM:The federal government, is in violation of its own laws, reimburses hospitals for care they give illegal aliens. Our tax dollars. This is because both state and federal law requires public hospitals to take care of any patient with an emergency medical condition. If the hospital refuses to treat an emergency patient it would get sued by the patient and be fined by both the state and federal governments. You want to take care of the problem? Have congress make the federal goventment abide by its own laws. (Lot's of luck!) It's not the hospitals fault!

    Part of a big mess wrote on Sep 5, 2007 10:51 AM:This is part of the general PPH mess. PPH tried to increase the tax on smokers and use it as a government subsidy - the voters were to smart for that one. They get over $10 million in property tax revenue per year which makes up most all their profit. They are $300 million over budget on their facilities expansion project and have built almost nothing. They overcharge the non-insured. They pay $2,000,000 to a football player in return for saying they are a great medical organization – how his football skills allow him to make this call isn’t clear, but anyway. And the list goes on…..

    The Hard Working wrote on Sep 5, 2007 11:37 AM:tax paying person gets hit again. Wow, because I went to school to get ahead, didn't have more kids then I could take care of, follow the law, have a good job with benefits I get to support all those that don't. I am sure my taxes will go up, my insurance rates will go up etc. This to make sure illegals can get care, those that feel society should pay for their kids get care and those that refuse to work get care.

    Less ripoffs wrote on Sep 5, 2007 12:10 PM:The state is tightening the noose on PPH and other mediocre hospitals. No longer will they be able to grossly overcharge the uninsured middle class consumer who stumbles in their doors. I am sure most did not realize that they were being charged much more than everyone else. A level playing field means less revenue for PPH and further concern as to the fiscal health of our community hospital district.

    I am confused wrote on Sep 5, 2007 1:48 PM:Let's see. When I try to pay my bill, I will first need to be taught by PPH staff how to apply for a discount that I should be entitled to automatically. However, if I slip up, I lose my discount or don't get it to start with. Creating transparent fair pricing for everyone but especially those who are paying without insurance is the only acceptable solution. Why all the double talk? Is PPH a predator of sick people?

    The young and uninsured wrote on Sep 5, 2007 3:42 PM:are also part of the equation that many of us forget about. My 21-year old daughter works full-time, but her employer has no health coverage. She won't be enrolled in college until next Fall, which means she's not eligible for my coverage. She can't walk into an ER or Drs. office and get discounted treatment. There's a huge population of our young adults that are between health coverage because they graduated high school or college and aren't eligible for their parents' insurance any more. At age 19 most - if not all -insurances deny coverage. If illegals are given special deals on health care or worse yet, given it for free, what a slap in the face to our young people who are working hard to try to make it in this world. Just remember: these young adults are of voting age - and I know my kids vote. They WILL remember how their needs were cast aside in favor of people who broke the law, despite the fact they are legal citizens.

    Enough wrote on Sep 5, 2007 4:06 PM:The Health Care system in this country is a mess and putting bandages on this mess just makes all of this more of a mess. Either the health Care providers (Insurance Companies, Hospitals, Doctors) join together and create an open market system that works fair for all, or the government will have to set up a Universal System. Try to imagine 10 more years of doing nothing except listening to political rhetoric. It is time to stop all the blabber and create a system that makes sense.

    NCT, where is the coverage... wrote on Sep 5, 2007 7:23 PM:of Mexican president Calderon's recent statements that finally give credence to the concerns of so many American citizens that Mexico is after more than just free health care? Come on, if ever there was a story relevant to this area, this is it. Where ARE YOU???

    To 'NCT where...' wrote on Sep 6, 2007 2:46 AM:Thanks, I was wondering the very same thing!!!

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