Hospitals Demand Payment Upfront From ER Patients With Routine Problems

Next time you go to an emergency room, be prepared for this: If your problem isn't urgent, you may have to pay upfront. Last year, about 80,000 emergency-room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening. At least half of all hospitals nationwide now charge upfront ER fees, said Rick Gundling, vice president of the Healthcare Financial Management Association, which represents health-care finance executives.

"It has been a successful part of helping to reduce crowding in emergency rooms and to encourage appropriate use of scarce resources," HCA spokesman Ed Fishbough said.
But emergency-room doctors and patient advocates blast the policy as potentially harmful to patients, and they say those with mild illnesses such as sore throats and ear infections do little to clog ERs and do not require CT scans or other pricey technologies.