Zuckerberg San Francisco General Hospital on Wednesday, Dec. 5, 2018. (Kevin N. Hume/S.F. Examiner)

SF General to revise billing policy that leaves patients with private insurance in debt

A long standing billing policy that has left insured patients receiving trauma and emergency services at Zuckerberg San Francisco General Hospital in debt will be overhauled, city leaders announced Friday.

While a large majority of the hospital’s patients are uninsured, about 6 percent have private insurance — and many reported receiving “surprise bills,” sometimes in the tens of thousands of dollars, as a result of the hospital’s policy against accepting private insurance.

As first reported by online news outlet Vox, the hospital is out of network with all private insurance plans, leaving some patients to shoulder the balance of their bills when their private insurers refuse to cover them.

The billing practice will be suspended for 90 days to allow for ZSFGH and the Department of Public Health, which manages the hospital, to develop a “comprehensive plan” for improvements.

The announcement was made in a joint statement issued Friday by Mayor London Breed, Supervisor Aaron Peskin, DPH and hospital officials.

“In an emergency, people’s focus should be on getting help quickly, not on what hospital they should go to,” said Breed, adding that private insurance companies “also need to be held accountable to actually pay for the healthcare for anyone they cover.”

Nina Dang is one of several former ZSFGH patients who came forward about the billing snafu in the year-long Vox investigation. Unaware that the hospital does not accept her insurance plan, Dang was transported to the hospital in an ambulance following a bike accident — months later, she was billed upwards of $20,000. The fee has since been reduced to $200.

Nurses at the hospital told the San Francisco Examiner last week that they disagreed with the policy.

“It says on the website, ‘We will take care of you regardless of your ability to pay,’ but there is no astrix or disclaimer saying, ‘We are going to charge you an exorbitant amount for services rendered,’” said Aaron Cramer, a longtime registered nurse. “This hospital is for all members of the public — private insurance or not — so I don’t think it’s fair for someone who has private insurance to be overcharged for care that’s equal to the care for someone that doesn’t have insurance.”

The billing practice’s suspension is effective immediately, and the hospital will “proactively begin the process of assessing a patient’s eligibility for assistance, rather than waiting for them to apply,” according to the statement.

Other changes will include adjusting charity care and sliding scale policies to expand the number of people who are eligible, streamlining the insurance application process and revising the hospital’s catastrophic high medical expense program “to support more patients who are faced with high, unexpected bills for catastrophic events.”

In the next 90 days, the hospital and health officials will also work to establish an “out-of-pocket maximum” for patient payments, pursue currently non-existent agreements with private insurance companies, and conduct a study of hospital charges regionally for comparison.

The hospital also promised to research billing and financial assistance practices of state public hospitals to identify areas in which it can improve, and conduct a “financial analysis of impact on the City of proposed changes.”

“While hospital billing in the United States is very complicated, patients should not be caught in the middle of disputes between hospitals and insurance companies,” said ZSFGH CEO Dr. Susan Ehrlich. “At ZSFGH, our mission is to provide high quality health care and trauma services with compassion and respect to everyone in San Francisco. We are working to ensure that our billing practices better align with that mission.”

lwaxmann@sfexaminer.com

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